Provider Demographics
NPI:1093787905
Name:CHEYENNE MOUNTAIN REHABILITATION, INC
Entity Type:Organization
Organization Name:CHEYENNE MOUNTAIN REHABILITATION, INC
Other - Org Name:CMR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-578-5957
Mailing Address - Street 1:660 SOUTHPOINTE CT
Mailing Address - Street 2:SUITE #100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3804
Mailing Address - Country:US
Mailing Address - Phone:719-578-5957
Mailing Address - Fax:719-576-7334
Practice Address - Street 1:660 SOUTHPOINTE CT
Practice Address - Street 2:SUITE #100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3804
Practice Address - Country:US
Practice Address - Phone:719-578-5957
Practice Address - Fax:719-576-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23979534Medicaid
CO23979534Medicaid