Provider Demographics
NPI:1386640126
Name:MONUMENT HEALTH NETWORK. INC.
Entity Type:Organization
Organization Name:MONUMENT HEALTH NETWORK. INC.
Other - Org Name:MONUMENT HEALTH CUSTER CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CUSTER LD-DWD MARKETS
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-717-6020
Mailing Address - Street 1:PO BOX 860013
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0013
Mailing Address - Country:US
Mailing Address - Phone:605-717-6020
Mailing Address - Fax:605-755-0694
Practice Address - Street 1:1065 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-1304
Practice Address - Country:US
Practice Address - Phone:605-673-2237
Practice Address - Fax:605-673-3593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10610314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD85032OtherWELLMARK
SD0151283Medicaid
SD051283Medicaid
85032OtherBLUE CROSS
SD0151283Medicaid