NPIMap

Organization Active NPI

The Moose Shack

  • Assisted Living Facility
  • Eagle River, AK
National Provider Identifier
1629472683
Registry record updated Oct 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
101077 Issued in AK
Legal business name
THE MOOSE SHACK
Practice address
19216 Citation Rd
Eagle River, AK 99577-8416
Phone
(907) 351-0569
NPI assigned
Oct 20, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2014

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

Authorized official

Name
Candis Denise Bishop
Title
Owner
Phone
(907) 351-0569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 101077 AK Primary

Addresses

Primary practice location

19216 Citation Rd
Eagle River, AK 99577-8416

Mailing address

19216 Citation Rd
Eagle River, AK 99577-8416
Phone (907) 351-0569

Other names 1

  • Autumn Sunrise Doing business as

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413763200000",
    "number": "1629472683",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MOOSE SHACK",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-20",
        "last_updated": "2014-10-20",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "CANDIS",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-351-0569"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "101077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Sunrise",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagle River, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.