Provider Demographics
NPI:1235174749
Name:VINTAGE PARK AT OSAWATOMIE LLC
Entity Type:Organization
Organization Name:VINTAGE PARK AT OSAWATOMIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-493-3165
Mailing Address - Street 1:1520 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-1702
Mailing Address - Country:US
Mailing Address - Phone:913-755-2167
Mailing Address - Fax:913-755-4855
Practice Address - Street 1:1520 PARKER AVE
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-1702
Practice Address - Country:US
Practice Address - Phone:913-755-2167
Practice Address - Fax:913-755-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNO61009310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility