Provider Demographics
NPI:1225183106
Name:IMELDA P SIPIN
Entity Type:Organization
Organization Name:IMELDA P SIPIN
Other - Org Name:SANTO NINO ASSISTED LIVING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:PAISTE
Authorized Official - Last Name:SIPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-646-1341
Mailing Address - Street 1:3610 HOLLYBERRY CR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2584
Mailing Address - Country:US
Mailing Address - Phone:907-646-1341
Mailing Address - Fax:907-646-1341
Practice Address - Street 1:2900 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3384
Practice Address - Country:US
Practice Address - Phone:907-646-1341
Practice Address - Fax:907-646-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000264310400000X
AK427933310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL 4054Medicaid