MEDICARE: RADIANT SHORE LIVING 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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1194695700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT SHORE LIVING LLC

Provider Business Mailing Address
First Line	:	1859 PARKVIEW AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-2617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1859 PARKVIEW AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-2617
Country	:	US
Telephone Number	:	973-619-8918
Fax Number	:	973-619-8918

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. HEMA LATCHMANSINGH
Credential	:
Telephone Number	:	973-619-8918

Provider Enumeration Date	:	11/08/2025
Last Update Date	:	11/08/2025

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Directions to “RADIANT SHORE LIVING LLC ” Practice Location

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