MEDICARE: RADIANT LIGHT HOME CARE LLP

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1073370953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT LIGHT HOME CARE LLP

Provider Business Mailing Address
First Line	:	3229 DANIA CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-2691
Country	:	US
Telephone Number	:	260-312-7251
Fax Number	:

Provider Business Practice Location Address
First Line	:	3184 ISLAND CLUB CT APT G
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-6107
Country	:	US
Telephone Number	:	260-312-7251
Fax Number	:

Authorized Official
Title or Position	:	CEO, PRESIDENT
Name	:	MR. SYLVESTER WILLIAMS JAVON WILLIAMS
Credential	:
Telephone Number	:	260-312-7251

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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