Healthcare Provider Details

I. General information

NPI: 1245884048
Provider Name (Legal Business Name): EPHPHATHA MEDICAL CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 MIDDLEFORD RD STE 501
SEAFORD DE
19973-3664
US

IV. Provider business mailing address

1350 MIDDLEFORD RD STE 501
SEAFORD DE
19973-3664
US

V. Phone/Fax

Practice location:
  • Phone: 925-222-9572
  • Fax:
Mailing address:
  • Phone: 925-222-9572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMANIE ELYSEE DORIVAL
Title or Position: MEDICAL PROVIDER
Credential: CRNP/FNP
Phone: 303-444-0190