Vintage Place of Derby

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

N087036 Issued in KS

Legal business name

VINTAGE PLACE OF DERBY

Practice address

1701 E Walnut Grove Rd
Derby, KS 67037-3528

Phone

(316) 788-9600

Fax

(316) 788-8963

NPI assigned

Feb 19, 2013

Last updated

Feb 19, 2013By the provider in NPPES

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 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1361232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361232000000",
    "number": "1568702181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 E WALNUT GROVE RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373528",
            "telephone_number": "316-788-9600",
            "fax_number": "316-788-8963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E WALNUT GROVE RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373528",
            "telephone_number": "316-788-9600",
            "fax_number": "316-788-8963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINTAGE PLACE OF DERBY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-19",
        "last_updated": "2013-02-19",
        "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": "N087036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KANSAS ASSISTED LIVING",
            "identifier": "N087036",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100416000A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2013; 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.