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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1639797475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT CARE, LLC

Provider Business Mailing Address
First Line	:	2380 WYCLIFF ST STE 200
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1257
Country	:	US
Telephone Number	:	952-247-7010
Fax Number	:	952-241-1693

Provider Business Practice Location Address
First Line	:	2380 WYCLIFF ST STE 200
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1257
Country	:	US
Telephone Number	:	952-247-7010
Fax Number	:	952-241-1693

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DAMA SAHID
Credential	:
Telephone Number	:	952-247-7010

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	11/13/2024

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