Organization
VINTAGE PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN WARREN (OWNER)
(316) 733-1144
Entity
Organization
Contact information
Practice address
1650 E 12TH AVE, EL DORADO, KS 67042-4300
(316) 321-7777
(316) 321-6115
Mailing address
1650 E 12TH AVE, EL DORADO, KS 67042-4300
(316) 321-7777
(316) 321-6115
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
N008009
KS
311500000X
Alzheimer Center (Dementia Center)
N008009
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N008009
STATE ASSISTED LIVING PROVIDER LICENSE NUMBER
KS
Enumeration date
07/13/2010
Last updated
07/13/2010
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