Healthcare Provider Details

I. General information

NPI: 1851508675
Provider Name (Legal Business Name): CHEYENNE COUNTY HOSPITAL ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CEDAR ST
JULESBURG CO
80737-1121
US

IV. Provider business mailing address

900 CEDAR ST
JULESBURG CO
80737-1121
US

V. Phone/Fax

Practice location:
  • Phone: 970-474-9833
  • Fax: 970-474-0905
Mailing address:
  • Phone: 970-474-9833
  • Fax: 970-474-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPENDING LICENSURE
License Number StateCO

VIII. Authorized Official

Name: MS. DANIELLE L GEARHART
Title or Position: CEO
Credential:
Phone: 308-254-5825