Vintage Park at Ottawa LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

N030008 Issued in KS

Legal business name

VINTAGE PARK AT OTTAWA LLC

Practice address

2250 S Elm St
Ottawa, KS 66067

Phone

(785) 242-3715

Fax

(785) 242-0188

NPI assigned

May 18, 2007

Last updated

Aug 22, 2020By 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. Matt Moore

Title

Senior Vice President

Phone

(913) 239-0660

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619185188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 S ELM ST",
            "city": "OTTAWA",
            "state": "KS",
            "postal_code": "66067",
            "telephone_number": "785-242-3715",
            "fax_number": "785-242-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 S ELM ST",
            "city": "OTTAWA",
            "state": "KS",
            "postal_code": "66067",
            "telephone_number": "785-242-3715",
            "fax_number": "785-242-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINTAGE PARK AT OTTAWA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "913-239-0660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "KS",
            "license": "N030008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Ottawa, KS
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• Assisted Living Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.