Provider Demographics
NPI:1790668440
Name:RADIANT LEGACY GROUP LLC
Entity type:Organization
Organization Name:RADIANT LEGACY GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIEPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-360-0998
Mailing Address - Street 1:6863 STARKEY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2782
Mailing Address - Country:US
Mailing Address - Phone:469-360-0998
Mailing Address - Fax:
Practice Address - Street 1:6863 STARKEY RIDGE LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2782
Practice Address - Country:US
Practice Address - Phone:469-360-0998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services