Provider Demographics
| NPI: | 1508610361 |
|---|---|
| Name: | RADIANT REFLECTIONS RESIDENTIAL LC |
| Entity Type: | Organization |
| Organization Name: | RADIANT REFLECTIONS RESIDENTIAL LC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MISS |
| Authorized Official - First Name: | JAMIE |
| Authorized Official - Middle Name: | CHANEL-LASHUN |
| Authorized Official - Last Name: | DANIELS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 346-599-4010 |
| Mailing Address - Street 1: | 9535 FOREST LN STE 119 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DALLAS |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 75243-6120 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 346-599-4010 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 9535 FOREST LN STE 119 |
| Practice Address - Street 2: | |
| Practice Address - City: | DALLAS |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 75243-6120 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 346-599-4010 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-04-16 |
| Last Update Date: | 2024-04-16 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
| No | 174200000X | Other Service Providers | Meals | |
| No | 251E00000X | Agencies | Home Health | |
| No | 251G00000X | Agencies | Hospice Care, Community Based | |
| No | 251J00000X | Agencies | Nursing Care | |
| No | 253Z00000X | Agencies | In Home Supportive Care | |
| No | 275N00000X | Hospital Units | Medicare Defined Swing Bed Unit | |
| No | 276400000X | Hospital Units | Rehabilitation, Substance Use Disorder Unit | |
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
| No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
| No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | |
| No | 311500000X | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) | |
| No | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
| No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
| No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
