06D0721948 CLIA NUMBER - CHEYENNE MANOR

Laboratory Demographics

  • CLIA Code: 06D0721948
  • Facility Name: CHEYENNE MANOR
  • Facility Address: 561 WEST 1ST NORTH
    CHEYENNE WELLS, CO
    ZIP 80810
  • Facility Phone: 719 767-5602
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: TARA GAYNOR
  • NPI Number: 1033590567
  • Taxonomy: 251E00000X - Home Health

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director TARA GAYNOR

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This page was last updated on: 9/29/2025