Organization
RADIANCE RENEWED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATANISHA WRIGHT (OWNER)
(219) 689-9104
Entity
Organization
Contact information
Practice address
9445 INDIANAPOLIS BLVD STE 1042, HIGHLAND, IN 46322-2648
(219) 689-9104
(985) 251-2701
Mailing address
9445 INDIANAPOLIS BLVD STE 1042, HIGHLAND, IN 46322-2648
(219) 689-9104
(985) 251-2701
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
04/26/2020
Last updated
04/26/2020
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