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General NPI Number Information
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NPI Number | 1790668440
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Entity Type | Organization
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Legal Business Name | RADIANT LEGACY GROUP LLC
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 6863 STARKEY RIDGE LN
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-2782
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Country | US
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Telephone | 469-360-0998
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Fax |
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Provider Business Mailing Address
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Address Line | 6863 STARKEY RIDGE LN
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-2782
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Country | US
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Telephone | 469-360-0998
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICER, OWNER
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Name | TENIKA PIEPER
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Credential |
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Telephone | 469-360-0998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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