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General NPI Number Information
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NPI Number | 1285191023
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Entity Type | Organization
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Legal Business Name | BSLC MONUMENT, LLC
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 55 BEACON LITE RD
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City | MONUMENT
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State | CO
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Zip | 80132-4400
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Country | US
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Telephone | 719-247-4400
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Fax | 719-481-9568
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Provider Business Mailing Address
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Address Line | 55 BEACON LITE RD
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City | MONUMENT
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State | CO
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Zip | 80132-4400
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Country | US
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Telephone | 719-247-4400
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Fax | 719-481-9568
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | NATHAN D MERRILL
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Credential |
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Telephone | 719-481-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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