17D0978758 CLIA NUMBER - VINTAGE PARK AT GARDNER

Laboratory Demographics

CLIA Number: 17D0978758

Facility Name: VINTAGE PARK AT GARDNER

Facility Address:
869 JUNIPER TERRACE ATTN EXECUTIVE DIRECTOR
GARDNER, KS
ZIP 66030
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Facility Phone Number: 913 884-8900

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1548226475

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name Field Value
CLIA Number 17D0978758
LAB Type Assisted Living Facility
Facility Name VINTAGE PARK AT GARDNER
Street 869 JUNIPER TERRACE ATTN EXECUTIVE DIRECTOR
City GARDNER
State KS
ZIP 66030
Phone 913 884-8900
CertificateType 4
CertificateEffectiveDate 10/3/2022
CertificateExpirationDate 10/2/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024