# CHENEY GOLDEN AGE HOME, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790770287
- **Authorized official:** JESSICA MARTIN (ADMINISTRATOR)
- **Authorized official phone:** (316) 540-3691

## Contact information

- **Practice address:** 724 N MAIN ST, CHENEY, KS 67025-9059
- **Practice address phone:** (316) 540-3691
- **Practice address fax:** (316) 542-0165
- **Mailing address:** PO BOX 370, CHENEY, KS 67025-0370
- **Mailing address phone:** (316) 540-3691
- **Mailing address fax:** (316) 542-0165

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 100108890A | KS | — |
| 314000000X | Skilled Nursing Facility | 100108890A | KS | Yes |

## Other

- **Enumeration date:** 09/12/2005
- **Last updated:** 10/16/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100108890A | — | KS |