Radiant Light Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

RADIANT LIGHT HOSPICE LLC

Practice address

2050 Steves Ave
San Antonio, TX 78210-5240

Phone

(210) 441-3189

Fax

(210) 568-4871

NPI assigned

Feb 27, 2024

Organization subpart

No

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

Authorized official

Name

Ms. Sandra Arredondo

Title

Owner/Ambr

Phone

(210) 441-3189

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194581033. Details of each certification follow.

• CCN A91762 Hospice · Active · Details

Hospice certification: CCN A91762

Legal name

RADIANT LIGHT HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Apr 23, 2025

Last certification

Apr 2, 2025

Ownership / control type

Proprietary - Other

Organization structure

LLCProprietary

Incorporated

Jan 26, 2024 in TX

Enrollment address

2050 Steves Ave
San Antonio, TX 78210-5240

Listed as

Radiant Light Hospice LLCCCN A91762 · All quality measures

Certified

Apr 23, 2025

Medicare certification status

ActiveFrom the Provider of Services file

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Ivan Edwards, D.O.

  • Physical Medicine & Rehabilitation Physician
  • San Antonio, TX
  • NPI 1700955176

  W-2 Managing Employee

  CMS ownership

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

{
    "created_epoch": "1708992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1194581033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 STEVES AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782105240",
            "telephone_number": "210-441-3189",
            "fax_number": "210-568-4871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 STEVES AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782105240",
            "telephone_number": "210-441-3189",
            "fax_number": "210-568-4871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT LIGHT HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-27",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "ARREDONDO",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "OWNER/AMBR",
        "authorized_official_telephone_number": "210-441-3189",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.