Provider Demographics
NPI:1295946358
Name:SWEET DREAMS,LLC
Entity type:Organization
Organization Name:SWEET DREAMS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROYCE
Authorized Official - Middle Name:BAIRD
Authorized Official - Last Name:BARTHOLOMEW
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:801-372-1888
Mailing Address - Street 1:5674 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GREEN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9914
Mailing Address - Country:US
Mailing Address - Phone:801-372-1888
Mailing Address - Fax:801-876-2727
Practice Address - Street 1:5674 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GREEN
Practice Address - State:UT
Practice Address - Zip Code:84050-9914
Practice Address - Country:US
Practice Address - Phone:801-372-1888
Practice Address - Fax:801-876-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT215642-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
115635OtherHEALTHPARTNERS
UT528884092034Medicaid
202038385 0001OtherCIGNA