Provider Demographics
NPI:1508174699
Name:RADIANT CARE HOSPICE LLC
Entity Type:Organization
Organization Name:RADIANT CARE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:VELASQUEZ
Authorized Official - Last Name:POBLETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-421-4400
Mailing Address - Street 1:7137 COLLEYVILLE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6457
Mailing Address - Country:US
Mailing Address - Phone:817-421-4400
Mailing Address - Fax:817-865-6351
Practice Address - Street 1:7137 COLLEYVILLE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6457
Practice Address - Country:US
Practice Address - Phone:817-421-4400
Practice Address - Fax:817-865-6351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based