Vintage Park at Holton, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

VINTAGE PARK AT HOLTON, LLC

Practice address

410 Juniper Dr
Holton, KS 66436-1535

Phone

(785) 364-5051

Fax

(785) 364-5010

NPI assigned

Aug 29, 2008

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

President

Phone

(949) 282-5800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Vintage Park at Holton Other name

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

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219968000000",
    "number": "1730337965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 JUNIPER DR",
            "city": "HOLTON",
            "state": "KS",
            "postal_code": "664361535",
            "telephone_number": "785-364-5051",
            "fax_number": "785-364-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 JUNIPER DR",
            "city": "HOLTON",
            "state": "KS",
            "postal_code": "664361535",
            "telephone_number": "785-364-5051",
            "fax_number": "785-364-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINTAGE PARK AT HOLTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-29",
        "last_updated": "2008-08-29",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-282-5800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BEING APPLIED FOR",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vintage Park at Holton",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Assisted Living Facility in Holton, KS
• Providers in Holton, 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 Aug 29, 2008; 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.