Provider Demographics
NPI:1922755800
Name:RADIANCE ENTERPRISE
Entity Type:Organization
Organization Name:RADIANCE ENTERPRISE
Other - Org Name:RADIANCE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALERY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-481-5212
Mailing Address - Street 1:1629 K ST NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1631
Mailing Address - Country:US
Mailing Address - Phone:240-481-5212
Mailing Address - Fax:
Practice Address - Street 1:1629 K ST NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1631
Practice Address - Country:US
Practice Address - Phone:240-481-5212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty