Healthcare Provider Details

I. General information

NPI: 1346104114
Provider Name (Legal Business Name): MONUMENT HEALTHCARE AND NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 36TH ST
SCOTTSBLUFF NE
69361-4636
US

IV. Provider business mailing address

325 PEMBROKE RD
BALA CYNWYD PA
19004-2826
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-2019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: YEDIDYA KAGANOFF
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 201-414-7854