Provider Demographics
NPI:1912763178
Name:RADIANT COMMUNITY CONNECTIONS LLC
Entity type:Organization
Organization Name:RADIANT COMMUNITY CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:VIKRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVDASANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-687-7375
Mailing Address - Street 1:288 SAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1613
Mailing Address - Country:US
Mailing Address - Phone:407-687-7375
Mailing Address - Fax:
Practice Address - Street 1:288 SAND HILL RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1613
Practice Address - Country:US
Practice Address - Phone:407-687-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services