Provider Demographics
NPI:1710467360
Name:RADIANT PRIVATE CARE, LLC
Entity Type:Organization
Organization Name:RADIANT PRIVATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:ANDREE
Authorized Official - Last Name:ALEXANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-907-8115
Mailing Address - Street 1:1480 NW 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5431
Mailing Address - Country:US
Mailing Address - Phone:954-907-8115
Mailing Address - Fax:
Practice Address - Street 1:1480 NW 52ND AVE
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-907-8115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care