MEDICARE: RADIANT REFLECTIONS RESIDENTIAL LC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	311ZA0620X	Adult Care Home Facility
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
3	323P00000X	Psychiatric Residential Treatment Facility
4	174200000X	Meals Provider
5	251E00000X	Home Health Agency
6	251G00000X	Community Based Hospice Care Agency
7	251J00000X	Nursing Care Agency
8	253Z00000X	In Home Supportive Care Agency
9	275N00000X	Medicare Defined Swing Bed Hospital Unit
10	276400000X	Substance Use Disorder Rehabilitation Hospital Unit
11	3104A0625X	Assisted Living Facility (Mental Illness)
12	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
13	310500000X	Mental Illness Intermediate Care Facility
14	311500000X	Alzheimer Center (Dementia Center)
15	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1508610361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT REFLECTIONS RESIDENTIAL LC

Provider Business Mailing Address
First Line	:	9535 FOREST LN STE 119
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-6120
Country	:	US
Telephone Number	:	346-599-4010
Fax Number	:

Provider Business Practice Location Address
First Line	:	9535 FOREST LN STE 119
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-6120
Country	:	US
Telephone Number	:	346-599-4010
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS JAMIE CHANEL-LASHUN DANIELS
Credential	:
Telephone Number	:	346-599-4010

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	04/16/2024

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