=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114810967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADIANCE COMMUNITY CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2025
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 297 OAKLAND CIR
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24502-3183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-478-2138
-----------------------------------------------------
Fax | 434-818-0937
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 297 OAKLAND CIR
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24502-3183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-478-2138
-----------------------------------------------------
Fax | 434-818-0937
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / CEO
-----------------------------------------------------
Name | GUIFALY CHRISTOLIN
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 954-478-2138
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------