Provider Demographics
NPI:1033514039
Name:RIDE WITH FAITH, INC
Entity Type:Organization
Organization Name:RIDE WITH FAITH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY-CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:BA/BS
Authorized Official - Phone:260-705-7513
Mailing Address - Street 1:2180 E MOWREY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-7611
Mailing Address - Country:US
Mailing Address - Phone:260-705-7513
Mailing Address - Fax:
Practice Address - Street 1:2180 E MOWREY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-7611
Practice Address - Country:US
Practice Address - Phone:260-705-7513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201037870AOtherMEDICAID LPI