=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508174699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADIANT CARE HOSPICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2010
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 749 JUSTIN RD
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75087-4840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-399-2155
-----------------------------------------------------
Fax | 469-399-2156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 717 N HARWOOD ST STE 550
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75201-6540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-628-9951
-----------------------------------------------------
Fax | 214-389-0976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | ANDREA BOHANNON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-628-9951
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------