MEDICARE: VINTAGE PARK AT BALDWIN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	N023018	KS

General Provider Information

NPI Number	:	1700842648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINTAGE PARK AT BALDWIN LLC

Provider Business Mailing Address
First Line	:	321 CRIMSON AVE
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-4157
Country	:	US
Telephone Number	:	785-594-4255
Fax Number	:	785-594-2280

Provider Business Practice Location Address
First Line	:	321 CRIMSON AVE
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-4157
Country	:	US
Telephone Number	:	785-594-4255
Fax Number	:	785-594-2280

Authorized Official
Title or Position	:	SR VICE PRESIDENT OF OPERATIONS
Name	:	MR. EDDIE PARADES
Credential	:
Telephone Number	:	210-493-3165

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	08/22/2020

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