Healthcare Provider Details

I. General information

NPI: 1366508368
Provider Name (Legal Business Name): RADIANT HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4609 SMARTY JONES DRIVE
KNIGHTDALE NC
27545
US

IV. Provider business mailing address

4609 SMARTY JONES DRIVE
KNIGHTDALE NC
27545
US

V. Phone/Fax

Practice location:
  • Phone: 919-790-9826
  • Fax: 240-359-7102
Mailing address:
  • Phone: 919-790-9826
  • Fax: 240-359-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberHC3598
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC3598
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License NumberHC3598
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHC3598
License Number StateNC

VIII. Authorized Official

Name: SOPHIA L. MBACKE
Title or Position: AGENCY ADMINISTRATOR
Credential:
Phone: 919-264-2916