Provider Demographics
NPI:1790565257
Name:SPIRITUALLY CONNECTED
Entity Type:Organization
Organization Name:SPIRITUALLY CONNECTED
Other - Org Name:SC WELLNESS RIDES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-637-4331
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-0295
Mailing Address - Country:US
Mailing Address - Phone:516-787-0721
Mailing Address - Fax:
Practice Address - Street 1:159 20TH ST STE 1B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-1254
Practice Address - Country:US
Practice Address - Phone:866-637-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle