Provider Demographics
NPI:1053000711
Name:RADIANT HEALTH SERVICES LLC
Entity type:Organization
Organization Name:RADIANT HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZICHE
Authorized Official - Middle Name:N
Authorized Official - Last Name:FOWAJUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-699-9853
Mailing Address - Street 1:305 KEAR ST
Mailing Address - Street 2:
Mailing Address - City:LOCKBOURNE
Mailing Address - State:OH
Mailing Address - Zip Code:43137
Mailing Address - Country:US
Mailing Address - Phone:954-699-9853
Mailing Address - Fax:
Practice Address - Street 1:305 KEAR ST
Practice Address - Street 2:
Practice Address - City:LOCKBOURNE
Practice Address - State:OH
Practice Address - Zip Code:43137
Practice Address - Country:US
Practice Address - Phone:954-699-9853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health