Provider Demographics
NPI:1902961105
Name:CHEYENNE COUNTY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:CHEYENNE COUNTY HOSPITAL ASSOCIATION
Other - Org Name:MEMORIAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-254-5070
Mailing Address - Street 1:645 OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-1714
Mailing Address - Country:US
Mailing Address - Phone:308-254-3273
Mailing Address - Fax:
Practice Address - Street 1:2 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-2549
Practice Address - Country:US
Practice Address - Phone:308-284-4078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251E00000X251E00000X
NE251G00000X251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========02Medicaid
NE=========02Medicaid