Provider Demographics
NPI:1124643499
Name:BEAR RIVER HEALTHCARE LLC
Entity type:Organization
Organization Name:BEAR RIVER HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-207-2726
Mailing Address - Street 1:646 S MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3273
Mailing Address - Country:US
Mailing Address - Phone:435-752-2291
Mailing Address - Fax:
Practice Address - Street 1:646 S MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3273
Practice Address - Country:US
Practice Address - Phone:435-752-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health