MEDICARE: MONUMENT SENIOR CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	04V724	CO

General Provider Information

NPI Number	:	1811231467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONUMENT SENIOR CARE LLC

Provider Business Mailing Address
First Line	:	2829 NORTH AVE
Second Line	:	SUITE 102
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-5368
Country	:	US
Telephone Number	:	970-985-4924
Fax Number	:	970-985-4925

Provider Business Practice Location Address
First Line	:	2829 NORTH AVE
Second Line	:	SUITE 102
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-5368
Country	:	US
Telephone Number	:	970-985-4924
Fax Number	:	970-985-4925

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JENNIFER BEAIRD KEMPTON
Credential	:
Telephone Number	:	970-858-2433

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	11/20/2012

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