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General NPI Number Information
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NPI Number | 1881598217
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Entity Type | Organization
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Legal Business Name | BEAR MOUNTAIN GROUP HOME, LLC
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 23812 DOLLY AVE
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City | CHUGIAK
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State | AK
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Zip | 99567-5577
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Country | US
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Telephone | 907-854-0443
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 670847
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City | CHUGIAK
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State | AK
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Zip | 99567-0847
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Country | US
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Telephone | 907-854-0443
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HOLLY CANNON
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Credential |
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Telephone | 907-854-0443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State | NULL
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