1689543027 NPI number — RADIANT WELLNESS & RECOVERY, A PROFESSIONAL NURSING CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689543027 NPI number — RADIANT WELLNESS & RECOVERY, A PROFESSIONAL NURSING CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIANT WELLNESS & RECOVERY, A PROFESSIONAL NURSING CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689543027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2108 N ST STE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95816-5712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-230-9768
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 47TH AVE STE 5A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95824-3847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-230-9768
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2025

Additional Information

Authorized Official

Authorized Official Last Name:
NDUNGU
Authorized Official First Name:
HERMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER / INCORPORATOR
Authorized Official Telephone Number:
916-230-9768

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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