Provider Demographics
NPI:1912307471
Name:RADIANT LIFE HOSPICE LLC
Entity Type:Organization
Organization Name:RADIANT LIFE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:KENYATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-509-3924
Mailing Address - Street 1:17902 HOLLOW HILL LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2576
Mailing Address - Country:US
Mailing Address - Phone:281-491-5085
Mailing Address - Fax:832-288-3524
Practice Address - Street 1:17902 HOLLOW HILL LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2576
Practice Address - Country:US
Practice Address - Phone:281-491-5085
Practice Address - Fax:832-288-3524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based