Organization
VINTAGE PARK AT HIAWATHA, LLC
Active
Other names
Vintage Park at Hiawatha
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATT MOORE (PRESIDENT)
(949) 282-5800
Entity
Organization
Contact information
Practice address
400 KANSAS AVE, HIAWATHA, KS 66434-1954
(785) 742-4566
(785) 742-4573
Mailing address
400 KANSAS AVE, HIAWATHA, KS 66434-1954
(785) 742-4566
(785) 742-4573
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BEING APPLIED FOR
—
KS
Enumeration date
08/29/2008
Last updated
08/29/2008
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