Organization
RADIANT CARE HOME
Active
Organization
RADIANT CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUBEN BONTILAO (MANAGER)
(623) 293-1396
Entity
Organization
Contact information
Practice address
15174 W BOCA RATON RD, SURPRISE, AZ 85379-8005
(623) 518-4534
(623) 518-4534
Mailing address
15174 W BOCA RATON RD, SURPRISE, AZ 85379-8005
(623) 518-4534
(623) 518-4534
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000000000
N/A
—
05
—
000000000000
—
AZ
Enumeration date
12/16/2018
Last updated
03/20/2023
Update your record
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