Radiant Care Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

RADIANT CARE HOME

Practice address

15174 W Boca Raton Rd
Surprise, AZ 85379-8005

Phone

(623) 518-4534

Fax

(623) 518-4534

NPI assigned

Dec 16, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Juben Bontilao

Title

Manager

Phone

(623) 293-1396

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1174094338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15174 W BOCA RATON RD",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853798005",
            "telephone_number": "623-518-4534",
            "fax_number": "623-518-4534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15174 W BOCA RATON RD",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853798005",
            "telephone_number": "623-518-4534",
            "fax_number": "623-518-4534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "BONTILAO",
        "authorized_official_first_name": "JUBEN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "623-293-1396",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000000000",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "00000000000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie M Que
• Queen Bee Wellness PLLC
• Star Quezada, PHARM D
• Bridgett Quinn
• Danielle Quisenberry, PHARMD
• Radiant Complexions Dermatology Clinics
• Cristina Radichel
• Breanna R Radosevich
• Raghav LLC
• Shirley Ann Rahilly, RPH

• Assisted Living Facility in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.