Provider Demographics
NPI:1982979423
Name:SAINT TIMOTHY HOME III
Entity type:Organization
Organization Name:SAINT TIMOTHY HOME III
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:CERVAS
Authorized Official - Last Name:ESCALANTE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:907-337-6364
Mailing Address - Street 1:11621 NIX CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3409
Mailing Address - Country:US
Mailing Address - Phone:907-337-6364
Mailing Address - Fax:907-338-6365
Practice Address - Street 1:12363 DIVISION ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3436
Practice Address - Country:US
Practice Address - Phone:907-337-6364
Practice Address - Fax:907-338-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility