Provider Demographics
NPI:1386393106
Name:KHARIS EPHRATA PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:KHARIS EPHRATA PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ODAMTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-775-0248
Mailing Address - Street 1:587 E STATE ROAD 434 UNIT 1025
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5284
Mailing Address - Country:US
Mailing Address - Phone:407-775-0248
Mailing Address - Fax:321-282-1448
Practice Address - Street 1:1030 WILDMEADOW RUN
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3032
Practice Address - Country:US
Practice Address - Phone:407-775-0248
Practice Address - Fax:407-951-7688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-20
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherI DO NOT HAVE SUCH NUMBERS