Provider Demographics
NPI:1699470450
Name:RADIANT RECOVERY & COUNSELING SERVICES
Entity type:Organization
Organization Name:RADIANT RECOVERY & COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-889-3924
Mailing Address - Street 1:400 S 4TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1419
Mailing Address - Country:US
Mailing Address - Phone:612-429-1662
Mailing Address - Fax:612-234-4788
Practice Address - Street 1:400 S 4TH ST STE 401
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1419
Practice Address - Country:US
Practice Address - Phone:612-429-1662
Practice Address - Fax:612-234-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health