Healthcare Provider Details

I. General information

NPI: 1174652903
Provider Name (Legal Business Name): CHEYENNE VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 CRYSTAL PARK RD CABIN MARSHALL
MANITOU SPRINGS CO
80829-2651
US

IV. Provider business mailing address

6275 LEHMAN DR
COLORADO SPRINGS CO
80918-1433
US

V. Phone/Fax

Practice location:
  • Phone: 719-685-5252
  • Fax:
Mailing address:
  • Phone: 719-592-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number0389
License Number StateCO

VIII. Authorized Official

Name: MRS. B. JEANNE SOLZE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-592-0200