Provider Demographics
NPI:1760483713
Name:MONUMENT HEALTH NETWORK, INC
Entity Type:Organization
Organization Name:MONUMENT HEALTH NETWORK, INC
Other - Org Name:MONUMENT HEALTH ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP RAPID CITY MARKET
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-720-2411
Mailing Address - Street 1:423 N 10 ST
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730
Mailing Address - Country:US
Mailing Address - Phone:605-673-5588
Mailing Address - Fax:605-673-4462
Practice Address - Street 1:423 N 10 ST
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730
Practice Address - Country:US
Practice Address - Phone:605-673-5588
Practice Address - Fax:605-673-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD41208310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9572070Medicaid
SD1760483713OtherNPI