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