Provider Demographics
NPI:1457712333
Name:RADIANCE HOSPICE, INC.
Entity type:Organization
Organization Name:RADIANCE HOSPICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-293-8686
Mailing Address - Street 1:4201 LONG BEACH BLVD.
Mailing Address - Street 2:STE 412A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2022
Mailing Address - Country:US
Mailing Address - Phone:949-293-8686
Mailing Address - Fax:818-588-4876
Practice Address - Street 1:15501 SAN FERNANDO MISSION BLVD STE 301
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1382
Practice Address - Country:US
Practice Address - Phone:818-588-4826
Practice Address - Fax:818-588-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Yes251G00000XAgenciesHospice Care, Community Based