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General NPI Number Information
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NPI Number | 1386393106
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Entity Type | Organization
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Legal Business Name | KHARIS EPHRATA PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 03/20/2022
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1030 WILDMEADOW RUN
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City | WINTER PARK
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State | FL
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Zip | 32792-3032
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Country | US
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Telephone | 407-775-0248
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Fax | 407-951-7688
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Provider Business Mailing Address
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Address Line | 587 E STATE ROAD 434 UNIT 1025
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City | LONGWOOD
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State | FL
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Zip | 32750-5284
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Country | US
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Telephone | 407-775-0248
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Fax | 321-282-1448
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Authorized Official
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Title or Position | OWNER
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Name | RUBY ODAMTTEN
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Credential | APRN
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Telephone | 407-775-0248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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