Healthcare Provider Details

I. General information

NPI: 1639092554
Provider Name (Legal Business Name): HEALTHY HOMESTEAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25439 SCHAFF DRIVE
CHUGIAK AK
99567
US

IV. Provider business mailing address

PO BOX 672629
CHUGIAK AK
99567-2629
US

V. Phone/Fax

Practice location:
  • Phone: 907-560-3962
  • Fax:
Mailing address:
  • Phone: 907-560-3962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN MOORE
Title or Position: OWNER
Credential: RN
Phone: 907-854-7033