Provider Demographics
NPI:1417304528
Name:MALUPO'S HAVEN ASSISTED LIVING HOME LLC
Entity Type:Organization
Organization Name:MALUPO'S HAVEN ASSISTED LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANTEL
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:BUNTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-602-8464
Mailing Address - Street 1:7221 KISKA CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3408
Mailing Address - Country:US
Mailing Address - Phone:907-222-0389
Mailing Address - Fax:907-222-0736
Practice Address - Street 1:7221 KISKA CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3408
Practice Address - Country:US
Practice Address - Phone:907-222-0389
Practice Address - Fax:907-222-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1011353104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances