Healthcare Provider Details

I. General information

NPI: 1861274813
Provider Name (Legal Business Name): EMMANUEL MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 DOUGLAS AVE STE 2
NORTH PROVIDENCE RI
02904-4057
US

IV. Provider business mailing address

10 DORRANCE ST STE 700
PROVIDENCE RI
02903-2014
US

V. Phone/Fax

Practice location:
  • Phone: 401-200-8242
  • Fax: 401-415-0418
Mailing address:
  • Phone: 401-200-8242
  • Fax: 401-415-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMOS ADELAIYE
Title or Position: OFFICE MANAGER
Credential:
Phone: 401-200-8242