Provider Demographics
NPI:1558800490
Name:RADIANT HOME CARE
Entity Type:Organization
Organization Name:RADIANT HOME CARE
Other - Org Name:RADIANT HOME HEALTH CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:OFOSUA
Authorized Official - Last Name:BONNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-879-1587
Mailing Address - Street 1:13236 W ANNIKA DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-8363
Mailing Address - Country:US
Mailing Address - Phone:505-722-9951
Mailing Address - Fax:505-722-9952
Practice Address - Street 1:101 S CLARK ST
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6678
Practice Address - Country:US
Practice Address - Phone:505-722-9951
Practice Address - Fax:505-722-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care