Provider Demographics
NPI:1194581033
Name:RADIANT LIGHT HOSPICE LLC
Entity type:Organization
Organization Name:RADIANT LIGHT HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AMBR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARREDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-441-3189
Mailing Address - Street 1:2050 STEVES AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-5240
Mailing Address - Country:US
Mailing Address - Phone:210-441-3189
Mailing Address - Fax:210-568-4871
Practice Address - Street 1:2050 STEVES AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-5240
Practice Address - Country:US
Practice Address - Phone:210-441-3189
Practice Address - Fax:210-568-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based