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General NPI Number Information
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NPI Number | 1114414463
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Entity Type | Organization
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Legal Business Name | ALTERARE ADVANTAGE LLC
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Dates
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Enumeration Date | 04/21/2018
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Last Update Date | 05/08/2021
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Provider Practice Location Address
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Address Line | 151 N. MAITLAND AVENUE 948514
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City | MAITLAND
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State | FL
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Zip | 32751-3275
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Country | US
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Telephone | 407-780-0177
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Fax |
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Provider Business Mailing Address
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Address Line | 2911 STONE GLEN WAY APT 107
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City | WINTER PARK
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State | FL
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Zip | 32792-1784
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Country | US
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Telephone | 407-780-0177
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAZZMYN ALYSSIA-MARIE IGLESIA
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Credential | MS BCBA
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Telephone | 407-780-0177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | FL
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