Provider Demographics
NPI:1710652979
Name:OUR RADIANCE INC.
Entity Type:Organization
Organization Name:OUR RADIANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JADE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-770-0152
Mailing Address - Street 1:8619 RESEDA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4048
Mailing Address - Country:US
Mailing Address - Phone:818-770-6900
Mailing Address - Fax:
Practice Address - Street 1:8619 RESEDA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4048
Practice Address - Country:US
Practice Address - Phone:818-770-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based