Provider Demographics
NPI:1821988155
Name:CHEYENNE TOTAL CARE LLC
Entity type:Organization
Organization Name:CHEYENNE TOTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-268-4577
Mailing Address - Street 1:2020 SHADY GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-2660
Mailing Address - Country:US
Mailing Address - Phone:469-844-4122
Mailing Address - Fax:469-590-0020
Practice Address - Street 1:2020 SHADY GLEN TRL
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-2660
Practice Address - Country:US
Practice Address - Phone:469-844-4122
Practice Address - Fax:469-590-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144110461Medicaid