NPIMap

Organization Active NPI

Radiant Home Health Care LLC

  • Home Health Agency
  • Gallup, NM
National Provider Identifier
1861891269
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
RADIANT HOME HEALTH CARE LLC
Practice address
1210 E Highway 66
Gallup, NM 87301-4993
Phone
(505) 722-9951
Fax
(505) 722-9952
NPI assigned
Aug 21, 2014
Last updated
Jan 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Authorized official

Name
Derrick Bonney, RN
Title
Ceo/Agency Program Director
Phone
(505) 722-9951

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Nursing Care Agency 251J00000X
In Home Supportive Care Agency 253Z00000X

Addresses

Primary practice location

1210 E Highway 66
Gallup, NM 87301-4993

Mailing address

1210 E Highway 66
Gallup, NM 87301-4993
Phone (505) 722-9951

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190603003120 NM Part A Provider - Home Health Agency 0446566392 Practice locations: Gallup, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861891269. Details of each certification follow.

Home health agency certification: CCN 327235

Legal name
RADIANT HOME HEALTH CARE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 17, 2020
Last certification
Jun 17, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Jan 1, 2019 in NM
Enrollment address
1210 E Historic Highway 66
Gallup, NM 87301-4993
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Radiant Home HealthcareCCN 327235 · All quality measures
Overall star rating
1.5 of 5
Ownership
Proprietary
Certified
Jun 17, 2020
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy

National Provider Directory

National Provider Directory
Tax ID family
Radiant Home Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Derrick Bonney Individual 5% Or Greater Direct Ownership InterestOwner/Administrator Jan 1, 2015 100%
Corporate DirectorOwner/Administrator Jan 1, 2015
W-2 Managing EmployeeAd; Jan 1, 2015
Operational/Managerial ControlOwner/Administrator Jan 1, 2015

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706572800000",
    "number": "1861891269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 E HIGHWAY 66",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873014993",
            "telephone_number": "505-722-9951",
            "fax_number": "505-722-9952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 E HIGHWAY 66",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873014993",
            "telephone_number": "505-722-9951",
            "fax_number": "505-722-9952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT HOME HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-21",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A",
        "authorized_official_last_name": "BONNEY",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "CEO/AGENCY PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "505-722-9951",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gallup, NM

Sources for this page

Verify at the official NPI Registry.