MEDICARE: CHEYENNE TOTAL CARE 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	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821988155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEYENNE TOTAL CARE LLC

Provider Business Mailing Address
First Line	:	2020 SHADY GLEN TRL
Second Line	:
City	:	PRINCETON
State	:	TX
Zip	:	75407-2660
Country	:	US
Telephone Number	:	469-844-4122
Fax Number	:	469-590-0020

Provider Business Practice Location Address
First Line	:	2020 SHADY GLEN TRL
Second Line	:
City	:	PRINCETON
State	:	TX
Zip	:	75407-2660
Country	:	US
Telephone Number	:	469-844-4122
Fax Number	:	469-590-0020

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. OCTAVIA ALLEN
Credential	:
Telephone Number	:	213-268-4577

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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Directions to “CHEYENNE TOTAL CARE LLC ” Practice Location

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