Provider Demographics
NPI:1174652903
Name:CHEYENNE VILLAGE, INC.
Entity Type:Organization
Organization Name:CHEYENNE VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:B. JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-592-0200
Mailing Address - Street 1:6275 LEHMAN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1433
Mailing Address - Country:US
Mailing Address - Phone:719-592-0200
Mailing Address - Fax:
Practice Address - Street 1:183 CRYSTAL PARK RD
Practice Address - Street 2:CABIN MARSHALL
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-2651
Practice Address - Country:US
Practice Address - Phone:719-685-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0389311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09140302Medicaid