THE MOOSE SHACK NPI 1629281126

NPI Information

NPI: 1629281126
Provider Name: THE MOOSE SHACK

Doing Business As: AUTUMN SUNRISE ASSISTED LIVING HOME

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
19216 CITATION RD
EAGLE RIVER, AK
ZIP 99577
Phone: (907) 351-0569
Get Directions

THE MOOSE SHACK is an assisted living facility in Eagle River, AK. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. THE MOOSE SHACK NPI is 1629281126. The provider is registered as an organization entity type.
The provider Is Doing Business As Autumn Sunrise Assisted Living Home.

The provider's business location address is:

19216 CITATION RD
EAGLE RIVER, AK
ZIP 99577-416
Phone: (907) 351-0569
Fax: (888) 291-5028

The provider's authorized official is Candis Denise Bishop .
The authorized official title is Ceo and has the following contact phone number (907) 351-0569.

The enumeration date for this NPI number is 5/8/2007 and was last updated on 10/10/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		000277	ALASKA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1030021	MEDICAID	ALASKA
2	RL09771	MEDICAID	ALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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