MEDICARE: CHEYENNE COUNTY VILLAGE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1225512304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEYENNE COUNTY VILLAGE INC

Provider Business Mailing Address
First Line	:	1654 US HIGHWAY 36
Second Line	:
City	:	SAINT FRANCIS
State	:	KS
Zip	:	67756-5915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S DENISON ST
Second Line	:
City	:	SAINT FRANCIS
State	:	KS
Zip	:	67756-3541
Country	:	US
Telephone Number	:	785-332-2531
Fax Number	:	785-332-2716

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	RYAN GRACE
Credential	:
Telephone Number	:	913-333-2843

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	11/06/2018

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Directions to “CHEYENNE COUNTY VILLAGE INC ” Practice Location

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