Organization
CHEYENNE TRACE, LLC
Active
Other names
Cheyenne Trace
Organization subpart
No
Provider details
NPI number
Authorized official
JAKE HALLSTED (PRESIDENT)
(832) 448-3700
Entity
Organization
Contact information
Practice address
14800 ST. MARY'S LANE, SUITE 175, HOUSTON, TX 77079
(832) 448-3700
Mailing address
420 CHEYENNE DR, JACKSON, TN 38305-5412
(731) 661-9888
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ACL0000000124
TN
Other
Enumeration date
07/09/2006
Last updated
08/22/2020
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