Healthcare Provider Details

I. General information

NPI: 1568433076
Provider Name (Legal Business Name): CHEYENNE LODGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 CEDAR ST
JAMESTOWN KS
66948-3007
US

IV. Provider business mailing address

716 CEDAR ST
JAMESTOWN KS
66948-3007
US

V. Phone/Fax

Practice location:
  • Phone: 785-439-6211
  • Fax: 785-439-6210
Mailing address:
  • Phone: 785-439-6211
  • Fax: 785-439-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberN-015-001
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN-015-001
License Number StateKS

VIII. Authorized Official

Name: MR. JOSEPH FUENTEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-439-6211