Provider Demographics
NPI:1386632594
Name:CHEYENNE HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:CHEYENNE HEALTH & WELLNESS CENTER
Other - Org Name:HEALTHWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:307-635-3618
Mailing Address - Street 1:2508 EAST FOX FARM ROAD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007
Mailing Address - Country:US
Mailing Address - Phone:307-635-3618
Mailing Address - Fax:307-635-1442
Practice Address - Street 1:2508 EAST FOX FARM ROAD
Practice Address - Street 2:SUITE 1A
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007
Practice Address - Country:US
Practice Address - Phone:307-635-3618
Practice Address - Fax:307-635-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW23769OtherPTAN
WYW23769OtherPTAN