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General NPI Number Information
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NPI Number | 1679296214
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Entity Type | Organization
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Legal Business Name | RADIANT LIGHT HOME CARE
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 1440 N 2ND ST FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3854
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Country | US
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Telephone | 267-916-3722
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 N 2ND ST FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3854
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Country | US
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Telephone | 267-916-3722
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARISOL ROSA
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Credential |
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Telephone | 267-916-3722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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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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