The Moose Shack, NPI 1629281126
Assisted Living Facility in Eagle River, AK, US

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NPI number: what is it?

The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...

NPI 1629281126
NPI Entity Type Organization
Provider Name The Moose Shack
Doing Business As
Enumeration Date September 30, 2009
Last Update Date September 30, 2009
Provider Location Address 19216 Citation Rd, Eagle River, AK, US
Provider Mailing Address 19216 Citation Rd, Eagle River, AK, US, 995778416
Is Sole Proprietor? No
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Organization Official

Official Name CEO Candis Denise Bishop
Official Position CEO
Phone 907-351-0569

Primary Taxonomy

Taxonomy Code

310400000X

Taxonomy Name Assisted Living Facility
Classification

Assisted Living Facility

Group

Nursing & Custodial Care Facilities

License No. 000277
License State AK
Description 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.

Other Organization Name

Autumn Sunrise Assisted Living Home
Doing Business As

Business Address

The Moose Shack
19216 Citation Rd

Eagle River, AK, US

Phone: 907-351-0569
Fax: 888-291-5028

Mailing Address

The Moose Shack
19216 Citation Rd
Eagle River, AK, US
ZIP 995778416
Phone: 907-351-0569
Fax: 888-291-5028

Other Identifiers

Identifier Identifier State Identifier Issuer Type/Code
RL09771 AK MEDICAID 05
1030021 AK MEDICAID 05

Other Providers in AK, US

NPI Name Taxonomy Address

1992450910

DPT Jenna Charlotte Nelson

Individual

Physical Therapist

122 1st Ave Ste 600

Fairbanks, AK

1457076820

FNP-BC Casey Griffith Womble

Individual

Family Nurse Practitioner

4000 Ambassador Dr

Anchorage, AK

1073271565

Sight Partners Physicians, P.c.

Organization

Ophthalmology Physician

2555 Phillips Field Rd

Fairbanks, AK

1306579164

Alyeska Imaging Center, Inc.

Organization

Diagnostic Radiology Physician

2480 S Woodworth Loop

Palmer, AK

1053926758

BCABA Bethany Joyanna Lee

Individual

Assistant Behavior Analyst

1175 N Leatherleaf Loop Ste C

Wasilla, AK

1497771109

D.O. Kendrick David Blais

Individual

Family Medicine Physician

1867 Airport Way Ste 140a

Fairbanks, AK

1013933209

Polar Wind Medical Center, Inc.

Organization

Family Medicine Physician

1867 Airport Way Ste 140a

Fairbanks, AK

1982329322

RD Marcel Leon Hollis

Individual

Registered Dietitian

436 5th Ave

Kotzebue, AK

1346965787

David Timothy Adams

Individual

Counselor

3650 N Campbell Rd

Palmer, AK

1649246836

MRS. MPAS PA-C Kathryn Elizabeth Steer

Individual

Family Medicine Physician

3455 Rewak Dr

Suite 103

Fairbanks, AK

1962127399

Catholic Social Services

Organization

Community/Behavioral Health Agency

3400 Spenard Rd

Anchorage, AK

1629538095

DR. DO Brian Paul Fremaux

Individual

Family Medicine Physician

230 E Marydale Ave

Soldotna, AK

1013499276

MS CCC SLP Christal Hays

Individual

Speech-Language Pathologist

4441 Diplomacy Dr

Anchorage, AK

1861004962

Morgan Dean Yaskus

Individual

Mental Health Counselor

8012 Stewart Mountain Dr

Eagle River, AK

1134844541

MS. Katelyn Tamara Holmberg

Individual

Counselor

1521 S Cushman St

Fairbanks, AK

1508977802

DR. MD Amy Elizabeth Dressel

Individual

Pediatrics Physician

1600 Glacier Ave

Juneau, AK

1912622481

Melissa Tasselli

Individual

Behavior Technician

16941 N Eagle River Loop Rd Ste 3

Eagle River, AK

1063800886

Johanna Clemens

Individual

Family Nurse Practitioner

350 14th Ave

Skagway, AK

1174248629

Pang Juan Lim

Individual

Day Training/Habilitation Specialist

1550 E 74th Ave

Anchorage, AK

1477278919

Michelle Kuehn

Individual

Day Training/Habilitation Specialist

1550 E 74th Ave

Anchorage, AK

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