MEDICARE: RADIANT CARE 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1457289308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT CARE LLC

Provider Business Mailing Address
First Line	:	4110 31ST AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3310
Country	:	US
Telephone Number	:	612-481-0788
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 31ST AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3310
Country	:	US
Telephone Number	:	612-481-0788
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FARDOWSO ABDINUR
Credential	:	RN
Telephone Number	:	612-481-0788

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “RADIANT CARE LLC ” Practice Location

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