- Enrollment id
- O20200508002068
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1457821639
- Multiple npi flag
- N
- Ccn
- B21683
- Associate id
- 2163853060
- Organization name
- RADIANT HOSPICE, INC
- Incorporation date
- 2018-11-21
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 19725 SHERMAN WAY
- Address line 2
- STE 295D
- City
- WINNETKA
- State
- CA
- Zip code
- 913063650