Provider Demographics
NPI:1598205684
Name:MONUMENTAL HEALTH SYSTEMS
Entity Type:Organization
Organization Name:MONUMENTAL HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:443-939-1001
Mailing Address - Street 1:3032 BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-3911
Mailing Address - Country:US
Mailing Address - Phone:443-939-1001
Mailing Address - Fax:
Practice Address - Street 1:3032 BRIGHTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-3911
Practice Address - Country:US
Practice Address - Phone:443-939-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD218061547251B00000X, 251E00000X, 251G00000X, 251J00000X, 251S00000X, 252Y00000X, 261QM0855X
MD218061548251F00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD218061548Medicaid
MD218061548Medicare PIN
MD218061548Medicaid
MD218061548Medicare UPIN