Provider Demographics
NPI:1972197465
Name:CHEYENNE OPCO LLC
Entity Type:Organization
Organization Name:CHEYENNE OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:ORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-838-0053
Mailing Address - Street 1:925 S NIAGARA ST STE 360
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1681
Mailing Address - Country:US
Mailing Address - Phone:347-838-0053
Mailing Address - Fax:
Practice Address - Street 1:2700 E 12TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5604
Practice Address - Country:US
Practice Address - Phone:307-634-7986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility