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General NPI Number Information
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NPI Number | 1407518228
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Entity Type | Organization
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Legal Business Name | RADIANT FAITH HOME CARE
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 3146 OVERLOOK TER
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City | SNELLVILLE
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State | GA
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Zip | 30078-3544
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Country | US
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Telephone | 404-587-9226
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Fax |
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Provider Business Mailing Address
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Address Line | 174 WATERLOCH CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-4497
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Country | US
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Telephone | 404-596-9272
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | CYNTHIA HICKS
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Credential |
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Telephone | 404-596-9272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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