Provider Demographics
NPI:1396344115
Name:RADIANCE FAMILY CARE LLC
Entity type:Organization
Organization Name:RADIANCE FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DOCMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:913-747-5374
Mailing Address - Street 1:16143 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8417
Mailing Address - Country:US
Mailing Address - Phone:913-747-5374
Mailing Address - Fax:
Practice Address - Street 1:1262 W AMITY ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-7815
Practice Address - Country:US
Practice Address - Phone:913-747-5374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care