Provider Demographics
NPI:1679448906
Name:RADIANT LIFE HOME CARE LLC
Entity type:Organization
Organization Name:RADIANT LIFE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FORSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-687-8646
Mailing Address - Street 1:1056 BROWNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-3233
Mailing Address - Country:US
Mailing Address - Phone:470-687-8646
Mailing Address - Fax:
Practice Address - Street 1:1056 BROWNSTONE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-3233
Practice Address - Country:US
Practice Address - Phone:470-687-8646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health