Healthcare Provider Details

I. General information

NPI: 1881598217
Provider Name (Legal Business Name): BEAR MOUNTAIN GROUP HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23812 DOLLY AVE
CHUGIAK AK
99567-5577
US

IV. Provider business mailing address

PO BOX 670847
CHUGIAK AK
99567-0847
US

V. Phone/Fax

Practice location:
  • Phone: 907-854-0443
  • Fax:
Mailing address:
  • Phone: 907-854-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name: HOLLY CANNON
Title or Position: OWNER
Credential:
Phone: 907-854-0443