Vintage Place

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

N008009 Issued in KS

Legal business name

VINTAGE PLACE

Practice address

1650 E 12TH Ave
El Dorado, KS 67042-4300

Phone

(316) 321-7777

Fax

(316) 321-6115

NPI assigned

Jul 13, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brian Warren

Title

Owner

Phone

(316) 733-1144

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278979200000",
    "number": "1255643698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 E 12TH AVE",
            "city": "EL DORADO",
            "state": "KS",
            "postal_code": "670424300",
            "telephone_number": "316-321-7777",
            "fax_number": "316-321-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 E 12TH AVE",
            "city": "EL DORADO",
            "state": "KS",
            "postal_code": "670424300",
            "telephone_number": "316-321-7777",
            "fax_number": "316-321-6115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINTAGE PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-13",
        "last_updated": "2010-07-13",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-733-1144",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "KS",
            "license": "N008009",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "KS",
            "license": "N008009",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ASSISTED LIVING PROVIDER LICENSE NUMBER",
            "identifier": "N008009",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in El Dorado, KS
• Providers in El Dorado, KS by specialty
• Assisted Living Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.