Organization
MONUMENTAL SUPPORTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WHITNEY CROCKETT BS,QIDP (OWNER)
(208) 949-1407
Entity
Organization
Contact information
Practice address
2103 W IZABELLA CT, NAMPA, ID 83651-1415
(208) 949-1407
Mailing address
2103 W IZABELLA CT, NAMPA, ID 83651-1415
(208) 949-1407
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/03/2026
Last updated
03/09/2026
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