Healthcare Provider Details

I. General information

NPI: 1154120327
Provider Name (Legal Business Name): CONNECTED IV LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 STRETFORD WAY APT 103
LANDOVER MD
20785-5951
US

IV. Provider business mailing address

650 STRETFORD WAY APT 103
LANDOVER MD
20785-5951
US

V. Phone/Fax

Practice location:
  • Phone: 202-491-8385
  • Fax:
Mailing address:
  • Phone: 202-491-8385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBERTA FAYE RINKER
Title or Position: OWNER, CEO
Credential: LICSW, LCSW-C, LCSW
Phone: 202-491-8385