Provider Demographics
NPI:1639521214
Name:SHINE BRIGHT CARE
Entity Type:Organization
Organization Name:SHINE BRIGHT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:MAI
Authorized Official - Last Name:KEODOUANGDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-602-5094
Mailing Address - Street 1:3007 ARCTIC BLVD SPC 2
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3478
Mailing Address - Country:US
Mailing Address - Phone:907-602-5094
Mailing Address - Fax:
Practice Address - Street 1:3007 ARCTIC BLVD SPC 2
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3478
Practice Address - Country:US
Practice Address - Phone:907-602-5094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health