Provider Demographics
NPI:1134302573
Name:SANTA FE CHEYENNE HOUSE
Entity Type:Organization
Organization Name:SANTA FE CHEYENNE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-634-8888
Mailing Address - Street 1:1000B S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2469
Mailing Address - Country:US
Mailing Address - Phone:405-793-1643
Mailing Address - Fax:405-793-1675
Practice Address - Street 1:1000B S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2469
Practice Address - Country:US
Practice Address - Phone:405-793-1643
Practice Address - Fax:405-793-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH1415315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37G145Medicare PIN