Provider Demographics
NPI:1609311430
Name:SHINE BRIGHT CARE, LLC
Entity type:Organization
Organization Name:SHINE BRIGHT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BAYKHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEODOUANGDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-250-9935
Mailing Address - Street 1:400 W NORTHERNLIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2149
Mailing Address - Country:US
Mailing Address - Phone:907-250-9935
Mailing Address - Fax:
Practice Address - Street 1:400 W NORTHERNLIGHTS BLVD
Practice Address - Street 2:STE 3
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3877
Practice Address - Country:US
Practice Address - Phone:907-346-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1039501251E00000X
253Z00000X, 320900000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty