1487879920 NPI number — CHEYENNE COUNTY HOSPITAL ASSOCIATION INC

Table of content: (NPI 1487879920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487879920 NPI number — CHEYENNE COUNTY HOSPITAL ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SLOAN'S ASSISTED LIVING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487879920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 OSAGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIDNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69162-1799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-254-5064
Provider Business Mailing Address Fax Number:
308-254-0869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 CRAIG AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIDNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69162-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-254-4801
Provider Business Practice Location Address Fax Number:
308-254-9777
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
UTLEY
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
308-254-5064

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  ALF108 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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