Provider Demographics
NPI:1417295031
Name:CHEYENNE MOUNTAIN CARE AND REHAB
Entity Type:Organization
Organization Name:CHEYENNE MOUNTAIN CARE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL SENIOR SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-328-7888
Mailing Address - Street 1:835 TENDERFOOT HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3903
Mailing Address - Country:US
Mailing Address - Phone:719-576-1060
Mailing Address - Fax:
Practice Address - Street 1:835 TENDERFOOT HILL RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3903
Practice Address - Country:US
Practice Address - Phone:719-576-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311ZA0620X
CO385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care