Healthcare Provider Details

I. General information

NPI: 1033590567
Provider Name (Legal Business Name): CHEYENNE COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W 1ST ST N
CHEYENNE WELLS CO
80810-9705
US

IV. Provider business mailing address

PO BOX 938
CHEYENNE WELLS CO
80810-0938
US

V. Phone/Fax

Practice location:
  • Phone: 719-767-5602
  • Fax: 719-767-5999
Mailing address:
  • Phone: 719-767-5602
  • Fax: 719-767-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04R708
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number04H568
License Number StateCO

VIII. Authorized Official

Name: M F SNYDER
Title or Position: ADMINISTRATOR
Credential: BA, NHA
Phone: 719-767-5602