Provider Demographics
NPI:1366508368
Name:RADIANT HEALTH CARE, INC
Entity type:Organization
Organization Name:RADIANT HEALTH CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MBACKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-264-2916
Mailing Address - Street 1:4609 SMARTY JONES DRIVE
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545
Mailing Address - Country:US
Mailing Address - Phone:919-790-9826
Mailing Address - Fax:240-359-7102
Practice Address - Street 1:4609 SMARTY JONES DRIVE
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545
Practice Address - Country:US
Practice Address - Phone:919-790-9826
Practice Address - Fax:240-359-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3598372600000X, 3747P1801X, 372500000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Not Answered372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
Not Answered376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC3598OtherNCDFS-LICENSE #