Organization
RADIANT HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK BONNEY (PROGRAM DIRECTOR)
(505) 722-9951
Entity
Organization
Contact information
Practice address
101 SOUTH CLARK STREET, GALLUP, NM 87301
(505) 722-9951
Mailing address
101 SOUTH CLARK STREET, GALLUP, NM 87301
(505) 722-9951
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
10/29/2014
Last updated
10/29/2014
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