Provider Demographics
NPI:1538465935
Name:MOUNT SINAI ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:MOUNT SINAI ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTNE
Authorized Official - Middle Name:CUNANAN
Authorized Official - Last Name:BOLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-350-2632
Mailing Address - Street 1:3951 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-6602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3951 SCENIC VIEW DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-6602
Practice Address - Country:US
Practice Address - Phone:907-350-2632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100869310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility