Provider Demographics
NPI:1477980803
Name:YSWECAN, LLC
Entity Type:Organization
Organization Name:YSWECAN, LLC
Other - Org Name:BRIGHTSTAR MOUNTAINSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-290-1290
Mailing Address - Street 1:5320 S 900 E STE 280
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7244
Mailing Address - Country:US
Mailing Address - Phone:801-290-1290
Mailing Address - Fax:801-290-1291
Practice Address - Street 1:5320 S 900 E STE 280
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-7244
Practice Address - Country:US
Practice Address - Phone:801-290-1290
Practice Address - Fax:801-290-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2013-HHA-UT00421251E00000X
UT2013-PCA-100630251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health