Provider Demographics
NPI:1821706730
Name:RADIANT HEARTS HOME CARE LLC
Entity Type:Organization
Organization Name:RADIANT HEARTS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORBIN
Authorized Official - Middle Name:KHRISTOFF
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-382-2189
Mailing Address - Street 1:7617 HEATHERLY LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5602
Mailing Address - Country:US
Mailing Address - Phone:858-260-9003
Mailing Address - Fax:
Practice Address - Street 1:7617 HEATHERLY LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-5602
Practice Address - Country:US
Practice Address - Phone:858-260-9003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care