Healthcare Provider Details

I. General information

NPI: 1083982813
Provider Name (Legal Business Name): RADIANT HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 SCENIC VALLEY PL
LANCASTER OH
43130-8470
US

IV. Provider business mailing address

1536 SCENIC VALLEY PL
LANCASTER OH
43130-8470
US

V. Phone/Fax

Practice location:
  • Phone: 740-777-1636
  • Fax:
Mailing address:
  • Phone: 740-777-1636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number201133400614
License Number StateOH

VIII. Authorized Official

Name: MR. MARTIN C DURU
Title or Position: PRESIDENT/ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 740-973-4370