MOOSE SHACK COFFEE NPI 1699962415

NPI Information

  • NPI: 1699962415
  • Provider Name: MOOSE SHACK COFFEE
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: AUTUMN SUNRISE
  • Address: 19216 CITATION RD
    EAGLE RIVER, AK
    ZIP 99577
  • Phone: (907) 351-0569

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NPI Details

MOOSE SHACK COFFEE 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. MOOSE SHACK COFFEE NPI is 1699962415. The provider is registered as an organization entity type.
The provider Is Doing Business As Autumn Sunrise.

The provider's business location address is:

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

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

The enumeration date for this NPI number is 9/25/2007 and was last updated on 9/19/2014.

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
1310400000XAssisted Living Facility101077ALASKAYes

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
1RL09771MEDICAIDALASKA

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: 11/21/2025

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