Provider Demographics
NPI:1457821639
Name:RADIANT HOSPICE, INC
Entity Type:Organization
Organization Name:RADIANT HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BIBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-441-3887
Mailing Address - Street 1:19725 SHERMAN WAY STE 295D
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3650
Mailing Address - Country:US
Mailing Address - Phone:818-441-3887
Mailing Address - Fax:
Practice Address - Street 1:19725 SHERMAN WAY STE 295D
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3650
Practice Address - Country:US
Practice Address - Phone:818-441-3887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based