NPIMap

Organization Active NPI

Bear River Healthcare LLC

Doing business as Symbii Hospice Bear River

  • Community Based Hospice Care Agency
  • Brigham City, UT
National Provider Identifier
1295350460
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
BEAR RIVER HEALTHCARE LLC
Doing business as
Symbii Hospice Bear River
Practice address
646 S Main St Ste 105
Brigham City, UT 84302-3273
Phone
(435) 752-2291
NPI assigned
Jun 12, 2020
Last updated
Jan 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amber L Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

646 S Main St Ste 105
Brigham City, UT 84302-3273

Mailing address

646 S Main St Ste 105
Brigham City, UT 84302-3273
Phone (435) 752-2291

Other names 1

  • Symbii Hospice Bear River Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200806000553 UT Part A Provider - Hospice 9830514983 Practice locations: Brigham City, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295350460. Details of each certification follow.

Hospice certification: CCN 461550

Legal name
BEAR RIVER HEALTHCARE LLC
Doing business as
SYMBII HOSPICE BEAR RIVER
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 9, 2005
Last certification
Sep 16, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Jun 11, 2020 in NV
Enrollment address
646 S Main St
Ste 105
Brigham City, UT 84302-3273

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Symbii Hospice Bear RiverCCN 461550 · All quality measures
Ownership
For-Profit
Certified
Jun 9, 2005
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Bear River Healthcare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jeremy R Deatry Individual W-2 Managing EmployeeAd; Aug 19, 2025
Todd James Miller Individual W-2 Managing EmployeeMD; Dec 1, 2025
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Direct Ownership Interest Jul 1, 2020 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 26, 2026
Brent Guerisoli Individual Corporate Director Aug 1, 2022
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2020 100%
John J Gochnour Individual Corporate OfficerManager Jun 12, 2024
Amber Tueller Individual Corporate OfficerSecretary Apr 10, 2024
Elliot McMillan Individual Corporate OfficerVice President Mar 26, 2026

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 141

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 141

Change-of-ownership history 1

DateEventCounterparty
Jul 1, 2020 Change of OwnershipThis provider was the buyer Signature Healthcare at Home- Nut HSCCN 461550, UT, NPI 1639561814

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1295350460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "646 S MAIN ST STE 105",
            "city": "BRIGHAM CITY",
            "state": "UT",
            "postal_code": "843023273",
            "telephone_number": "435-752-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "646 S MAIN ST STE 105",
            "city": "BRIGHAM CITY",
            "state": "UT",
            "postal_code": "843023273",
            "telephone_number": "435-752-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAR RIVER HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-12",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Symbii Hospice Bear River",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brigham City, UT

Sources for this page

Verify at the official NPI Registry.