Healthcare Provider Details

I. General information

NPI: 1417295031
Provider Name (Legal Business Name): CHEYENNE MOUNTAIN CARE AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 TENDERFOOT HILL RD
COLORADO SPRINGS CO
80906-3903
US

IV. Provider business mailing address

835 TENDERFOOT HILL RD
COLORADO SPRINGS CO
80906-3903
US

V. Phone/Fax

Practice location:
  • Phone: 719-576-1060
  • Fax:
Mailing address:
  • Phone: 719-576-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateCO

VIII. Authorized Official

Name: MS. MARTHA BRUNETTE
Title or Position: REGIONAL SENIOR SUPERVISOR
Credential:
Phone: 303-328-7888