Provider Demographics
NPI:1871460162
Name:RADIANT LIFE GROUP HOMES, LLC
Entity type:Organization
Organization Name:RADIANT LIFE GROUP HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER ; ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELVU
Authorized Official - Suffix:
Authorized Official - Credentials:COO AND TEAM LEADER
Authorized Official - Phone:352-386-6482
Mailing Address - Street 1:2852 HICKORY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3066
Mailing Address - Country:US
Mailing Address - Phone:352-386-6482
Mailing Address - Fax:
Practice Address - Street 1:2852 HICKORY CREEK DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3066
Practice Address - Country:US
Practice Address - Phone:352-386-6482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL126054100Medicaid