MEDICARE: BEAR RIVER HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1295350460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAR RIVER HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	646 S MAIN ST STE 105
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-3273
Country	:	US
Telephone Number	:	435-752-2291
Fax Number	:

Provider Business Practice Location Address
First Line	:	646 S MAIN ST STE 105
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-3273
Country	:	US
Telephone Number	:	435-752-2291
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	AMBER L TUELLER
Credential	:
Telephone Number	:	208-207-2726

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	01/23/2025

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Directions to “BEAR RIVER HEALTHCARE LLC ” Practice Location

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