Provider Demographics
NPI:1730051756
Name:ONEDAYRIDER
Entity type:Organization
Organization Name:ONEDAYRIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:KIBONGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALEKE
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:817-450-0048
Mailing Address - Street 1:8665 LAS VEGAS CT APT 3020
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0057
Mailing Address - Country:US
Mailing Address - Phone:817-450-0048
Mailing Address - Fax:
Practice Address - Street 1:8665 LAS VEGAS CT APT 3020
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-0057
Practice Address - Country:US
Practice Address - Phone:817-450-0048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIBONGE BALEKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty