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1407735699 NPI number — RADIANT LIFE RESIDENTIAL CARE, INC.

NPI Number: 1407735699
Health Care Provider/Practitioner: RADIANT LIFE RESIDENTIAL CARE, INC.

Information about “1407735699” NPI (RADIANT LIFE RESIDENTIAL CARE, INC.) exists in 1407735699 in HTML format HTML  |  1407735699 in plain Text format TXT  |  1407735699 in PDF (Portable Document Format) PDF  |  1407735699 in an XML format XML  formats.

NPI Number : 1407735699 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407735699",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RADIANT LIFE RESIDENTIAL CARE, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3324 RUE ROYALE ST # 1147",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT CHARLES",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63301-8321",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-697-2298",
    "MailingAddressFaxNumber": "314-405-9394",
    "FirstLinePracticeLocationAddress": "1545 SHADOW LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT CHARLES",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63303-5023",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-697-2298",
    "PracticeLocationAddressFaxNumber": "314-405-9394",
    "EnumerationDate": "09/01/2025",
    "LastUpdateDate": "09/01/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FAULKNER",
    "AuthorizedOfficialFirstName": "VICTORIA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "AGENCY DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DNP",
    "AuthorizedOfficialTelephoneNumber": "314-697-2298",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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