Healthcare Provider Details

I. General information

NPI: 1457712333
Provider Name (Legal Business Name): RADIANCE HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15501 SAN FERNANDO MISSION BLVD STE 301
MISSION HILLS CA
91345-1382
US

IV. Provider business mailing address

4201 LONG BEACH BLVD. STE 412A
LONG BEACH CA
90807-2022
US

V. Phone/Fax

Practice location:
  • Phone: 818-588-4826
  • Fax: 818-588-4876
Mailing address:
  • Phone: 949-293-8686
  • Fax: 818-588-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: KENT E CHESLEY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 949-293-8686