Provider Demographics
NPI:1568906477
Name:RADIANT CARE AFH 'LLC'
Entity Type:Organization
Organization Name:RADIANT CARE AFH 'LLC'
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:NAKKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-861-8388
Mailing Address - Street 1:52 NW BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146
Mailing Address - Country:US
Mailing Address - Phone:503-861-8388
Mailing Address - Fax:503-861-8387
Practice Address - Street 1:52 NW BIRCH CT
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:503-861-8388
Practice Address - Fax:503-861-8387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIANT CARE AFH 'LLC'
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home