Moose Shack Coffee

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

101077 Issued in AK

Legal business name

MOOSE SHACK COFFEE

Doing business as

Autumn Sunrise

Practice address

19216 Citation Rd
Eagle River, AK 99577-8416

Phone

(907) 351-0569

NPI assigned

Sep 25, 2007

Last updated

Sep 19, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Candis Denise Bishop

Title

Owner

Phone

(907) 351-0569

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Autumn Sunrise 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.

• The Moose Shack

  dba Autumn Sunrise Assisted Living Home

  • Assisted Living Facility
  • Eagle River, AK
  • NPI 1629281126
  NPD tax ID
• The Moose Shack

  dba Autumn Sunrise

  • 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": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411084800000",
    "number": "1699962415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7531 RANDAMAR PL",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995075718",
            "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": "MOOSE SHACK COFFEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2014-09-19",
        "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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "101077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RL09771",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Sunrise",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kaitlyn Andrea Moore, OD
• Maile Moore, RN
• Makenzee Moore
• Marie Lanora Moore, APRN
• Robert Charles Moore, R.PH.
• More Than Meds LLC
• Arsenia Villajuan Morgan, LPN
• Emily Morgan, PHARMD
• Emily Morgester
• Sydney Morris

• 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 Sep 19, 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.