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06D0721948 CLIA NUMBER - CHEYENNE MANOR

Laboratory Demographics

CLIA Number: 06D0721948

Facility Name: CHEYENNE MANOR

Facility Address:
561 WEST 1ST NORTH
CHEYENNE WELLS, CO
ZIP 80810
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Facility Phone Number: 719 767-5602

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver
NPI Number: 1033590567

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 06D0721948
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CHEYENNE MANOR
Street 561 WEST 1ST NORTH
City CHEYENNE WELLS
State CO
ZIP 80810
Phone 719 767-5602
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024