Provider Demographics
NPI:1285851642
Name:VINTAGE PARK APARTMENTS, INC
Entity Type:Organization
Organization Name:VINTAGE PARK APARTMENTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-336-2395
Mailing Address - Street 1:810 E VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:IA
Mailing Address - Zip Code:50851-1622
Mailing Address - Country:US
Mailing Address - Phone:641-333-2233
Mailing Address - Fax:641-333-2237
Practice Address - Street 1:810 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:IA
Practice Address - Zip Code:50851-1622
Practice Address - Country:US
Practice Address - Phone:641-333-2233
Practice Address - Fax:641-333-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0179310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0414961Medicaid
IAS0179OtherASSISTEDLIVINGCERTIFICATE