# SSC CHEYENNE OPERATING COMPANY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cheyenne Healthcare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053432336
- **Authorized official:** THOMAS P. SIMONS (SENIOR VP OPERATIONS FINANCE)
- **Authorized official phone:** (770) 829-5100

## Contact information

- **Practice address:** 2700 E 12TH ST, CHEYENNE, WY 82001-5604
- **Practice address phone:** (307) 634-7986
- **Mailing address:** 5300 W SAM HOUSTON PKWY N, SUITE 100, HOUSTON, TX 77041-5161
- **Mailing address phone:** (832) 467-6000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 07063 | WY | Yes |

## Other

- **Enumeration date:** 04/03/2007
- **Last updated:** 11/11/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0107449100WY | PREVIOUS MEDICAID NUMBER | WY |
| 05 | — | 120858600 | — | WY |