Provider Demographics
NPI:1871089730
Name:MONUMENT ASSISTED LIVING CARE CENTER, LLC
Entity type:Organization
Organization Name:MONUMENT ASSISTED LIVING CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-241-6562
Mailing Address - Street 1:2194 MCKINLEY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-1139
Mailing Address - Country:US
Mailing Address - Phone:970-241-6562
Mailing Address - Fax:970-241-7494
Practice Address - Street 1:2194 MCKINLEY DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-1139
Practice Address - Country:US
Practice Address - Phone:970-241-6562
Practice Address - Fax:970-241-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO230238310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility