# VINTAGE PARK AT FREDONIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vintage Park at Fredonia
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922256155
- **Authorized official:** MR. MATT MOORE (PRESIDENT)
- **Authorized official phone:** (949) 282-5800

## Contact information

- **Practice address:** 2111 E WASHINGTON ST, FREDONIA, KS 66736-1757
- **Practice address phone:** (620) 378-2329
- **Practice address fax:** (620) 378-2792
- **Mailing address:** 2111 E WASHINGTON ST, FREDONIA, KS 66736-1757
- **Mailing address phone:** (620) 378-2329
- **Mailing address fax:** (620) 378-2792

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | BEING APPLIED FOR | KS | Yes |

## Other

- **Enumeration date:** 08/29/2008
- **Last updated:** 08/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | BEING APPLIED FOR | — | KS |