MEDICARE: RADIANT HILLS HEALTH ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053306811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT HILLS HEALTH ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	9155 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020
Country	:	US
Telephone Number	:	602-218-9483
Fax Number	:	602-944-8549

Provider Business Practice Location Address
First Line	:	9155 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020
Country	:	US
Telephone Number	:	602-218-9483
Fax Number	:	602-944-8549

Authorized Official
Title or Position	:	TREASURER
Name	:	MS. SOON BURNAM
Credential	:
Telephone Number	:	949-540-1249

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	02/16/2021

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