| Organization Name: | THE MOOSE SHACK |
| NPI Number: | 1629472683 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CANDIS DENISE BISHOP (OWNER) |
| Mailing Address: | 19216 Citation Rd Eagle River |
| State: | AK US |
| Postal Code: | 995778416 |
| Phone Number: | 9073510569 |
| Fax Number: | |
| NPI Enumeration Date: | 10/20/2014 |
| NPI Last Update Date: | 10/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | 101077 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | 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. |