Healthcare Provider Details

I. General information

NPI: 1568071561
Provider Name (Legal Business Name): OGMA COMMUNITY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 LAKE ELLENOR DR STE 156
ORLANDO FL
32809-6200
US

IV. Provider business mailing address

7200 LAKE ELLENOR DR STE 156
ORLANDO FL
32809-6200
US

V. Phone/Fax

Practice location:
  • Phone: 407-693-2925
  • Fax:
Mailing address:
  • Phone: 407-693-2925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: OLAIDA G MONTILLA ALVAREZ
Title or Position: PRESIDENT
Credential:
Phone: 407-693-2925