Healthcare Provider Details

I. General information

NPI: 1407306038
Provider Name (Legal Business Name): MONUMENT HEALTH HOME PLUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HAINES AVE
RAPID CITY SD
57701-0616
US

IV. Provider business mailing address

PO BOX 860013
MINNEAPOLIS MN
55486-0013
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-9000
  • Fax: 605-755-9010
Mailing address:
  • Phone: 605-755-7649
  • Fax: 605-755-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TILLES
Title or Position: PRESIDENT-MONUMENT HEALTH HOME PLUS
Credential:
Phone: 605-519-1179