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General NPI Number Information
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NPI Number | 1154120327
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Entity Type | Organization
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Legal Business Name | CONNECTED IV LIFE
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 650 STRETFORD WAY APT 103
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City | LANDOVER
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State | MD
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Zip | 20785-5951
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Country | US
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Telephone | 202-491-8385
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Fax |
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Provider Business Mailing Address
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Address Line | 650 STRETFORD WAY APT 103
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City | LANDOVER
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State | MD
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Zip | 20785-5951
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Country | US
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Telephone | 202-491-8385
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | MS. ROBERTA FAYE RINKER
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Credential | LICSW, LCSW-C, LCSW
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Telephone | 202-491-8385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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