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General NPI Number Information
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NPI Number | 1154276202
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Entity Type | Organization
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Legal Business Name | MONUMENTAL SUPPORTED LIVING LLC
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 2103 W IZABELLA CT
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City | NAMPA
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State | ID
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Zip | 83651-1415
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Country | US
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Telephone | 208-949-1407
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 W IZABELLA CT
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City | NAMPA
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State | ID
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Zip | 83651-1415
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Country | US
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Telephone | 208-949-1407
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WHITNEY KAY CROCKETT
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Credential | BS,QIDP
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Telephone | 208-949-1407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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