MEDICARE: RADIANT LIGHT HOSPICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1194581033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT LIGHT HOSPICE LLC

Provider Business Mailing Address
First Line	:	2050 STEVES AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-5240
Country	:	US
Telephone Number	:	210-441-3189
Fax Number	:	210-568-4871

Provider Business Practice Location Address
First Line	:	2050 STEVES AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-5240
Country	:	US
Telephone Number	:	210-441-3189
Fax Number	:	210-568-4871

Authorized Official
Title or Position	:	OWNER/AMBR
Name	:	MS. SANDRA ARREDONDO
Credential	:
Telephone Number	:	210-441-3189

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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Directions to “RADIANT LIGHT HOSPICE LLC ” Practice Location

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