Vintage Park at Fredonia, LLC
Organization Active NPI Assisted Living Facility · Fredonia, KS
NPI 1922256155 · NPPES record last updated Aug 29, 2008
Key facts
- NPI
- 1922256155
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- BEING APPLIED FOR (KS)
- Legal business name
- VINTAGE PARK AT FREDONIA, LLC
- Practice address
- 2111 E Washington St
Fredonia, KS 66736-1757 - Phone
- (620) 378-2329
- Fax
- (620) 378-2792
- NPI assigned
- Aug 29, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Matt Moore
- Title
- President
- Phone
- (949) 282-5800
National Provider Directory
Locations
2111 E Washington St
Fredonia, KS 66736
Phone (620) 378-2329
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | BEING APPLIED FOR | KS | Yes |
Addresses
Primary practice location
2111 E Washington St
Fredonia, KS 66736-1757
Mailing address
2111 E Washington St
Fredonia, KS 66736-1757
Phone (620) 378-2329
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BEING APPLIED FOR | Medicaid | KS |
Other names
- Vintage Park at Fredonia
Other providers in Fredonia, KS
- Cherie Farrar Starbuck
- Steven a Kuhl OD, LLC
- Britni Dawn Stewart
- Beverly Lorraine Tasche
- Usd 484 Fredonia
- Wilson County Health Department
All providers in Fredonia, KS · Assisted Living Facility in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.