The Moose Shack

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

000277 Issued in AK

Legal business name

THE MOOSE SHACK

Doing business as

Autumn Sunrise Assisted Living Home

Practice address

19216 Citation Rd
Eagle River, AK 99577-8416

Phone

(907) 351-0569

Fax

(888) 291-5028

NPI assigned

May 8, 2007

Organization subpart

No

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

Authorized official

Name

Candis Denise Bishop, CEO

Title

Ceo

Phone

(907) 351-0569

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Autumn Sunrise Assisted Living Home Doing business as

Tax ID family

Autumn Sunrise3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Moose Shack Coffee

  • Assisted Living Facility
  • Eagle River, AK
  • NPI 1699962415
  NPD tax ID
• The Moose Shack

  • Assisted Living Facility
  • Eagle River, AK
  • NPI 1629472683
  NPD tax ID

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412899200000",
    "number": "1629281126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19216 CITATION RD",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778416",
            "telephone_number": "907-351-0569",
            "fax_number": "888-291-5028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19216 CITATION RD",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778416",
            "telephone_number": "907-351-0569",
            "fax_number": "888-291-5028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MOOSE SHACK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2014-10-10",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "CANDIS",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-351-0569",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "000277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RL09771",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1030021",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Sunrise Assisted Living Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christine Ann Tasso, OD
• Megan Taylor, N.D.
• Samantha H Taylor, RN, LMT, BCTMB
• Liam Paul Terry
• Susan Kay Terwilliger, LM,CPM,CDM
• The Moose Shack
• The Osterbauer Clinic LLC
• The Talking Place Child & Adolescent Counseling LLC
• Thomas Knolmayer MD LLC
• Anna Thomas

• Assisted Living Facility in Eagle River, AK
• Providers in Eagle River, AK by specialty
• Assisted Living Facility in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.