Healthcare Provider Details

I. General information

NPI: 1265202337
Provider Name (Legal Business Name): RADIANT HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 FRIENDLY ST
EUGENE OR
97405-2254
US

IV. Provider business mailing address

2775 FRIENDLY ST
EUGENE OR
97405-2254
US

V. Phone/Fax

Practice location:
  • Phone: 541-951-9995
  • Fax:
Mailing address:
  • Phone: 541-951-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KAYA SKYE
Title or Position: MANAGING MEMBER
Credential: LMT
Phone: 541-951-9995