Provider Demographics
NPI:1922586809
Name:EMMAUS HEALTH LLC
Entity Type:Organization
Organization Name:EMMAUS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-553-3020
Mailing Address - Street 1:945 MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6064
Mailing Address - Country:US
Mailing Address - Phone:860-553-3020
Mailing Address - Fax:860-553-3232
Practice Address - Street 1:945 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6064
Practice Address - Country:US
Practice Address - Phone:860-553-3020
Practice Address - Fax:860-553-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3886261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care