Organization
VINTAGE PLACE OF DERBY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN WARREN (OWNER)
(316) 733-1144
Entity
Organization
Contact information
Practice address
1701 E WALNUT GROVE RD, DERBY, KS 67037-3528
(316) 788-9600
(316) 788-8963
Mailing address
1701 E WALNUT GROVE RD, DERBY, KS 67037-3528
(316) 788-9600
(316) 788-8963
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
N087036
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100416000A
—
KS
01
—
N087036
KANSAS ASSISTED LIVING
KS
Enumeration date
02/19/2013
Last updated
02/19/2013
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