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General NPI Number Information
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NPI Number | 1114240132
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Entity Type | Organization
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Legal Business Name | CHEYENNE TOTAL CARE LLC
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Dates
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Enumeration Date | 03/04/2010
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 104 WEST FRANKLIN STREET SUITE E
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City | TUPELO
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State | MS
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Zip | 38804
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Country | US
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Telephone | 662-436-4635
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Fax | 662-796-8860
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Provider Business Mailing Address
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Address Line | 104 WEST FRANKLIN STREET SUITE E
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City | TUPELO
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State | MS
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Zip | 38804
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Country | US
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Telephone | 662-436-4635
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Fax | 662-796-8860
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. PATRICIA ANN CLAY
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Credential |
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Telephone | 662-436-4635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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