Provider Demographics
NPI:1093582892
Name:RADIANCE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:RADIANCE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OMOLARA
Authorized Official - Middle Name:AMINAT
Authorized Official - Last Name:OSHOKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP
Authorized Official - Phone:312-878-5588
Mailing Address - Street 1:100 S STATE ST STE 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-5513
Mailing Address - Country:US
Mailing Address - Phone:855-686-9444
Mailing Address - Fax:312-900-9373
Practice Address - Street 1:100 S STATE ST STE 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-5513
Practice Address - Country:US
Practice Address - Phone:855-686-9444
Practice Address - Fax:312-900-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty