MEDICARE: RADIANCE RESIDENTIAL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	174200000X	Meals Provider
3	177F00000X	Lodging Provider
4	251J00000X	Nursing Care Agency
5	311ZA0620X	Adult Care Home Facility
6	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
7	251S00000X	Community/Behavioral Health Agency
8	347C00000X	Private Vehicle
9	385H00000X	Respite Care
10	253Z00000X	In Home Supportive Care Agency
11	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1568266906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANCE RESIDENTIAL LLC

Provider Business Mailing Address
First Line	:	2928 BRIARCHASE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-5087
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2928 BRIARCHASE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-5087
Country	:	US
Telephone Number	:	317-698-9989
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DIANA DENISE BARNES
Credential	:	RN
Telephone Number	:	317-698-9989

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	04/03/2025

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