MEDICARE: A GREAT LIFE SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LMHC 10628	FL
2	103K00000X	Behavior Analyst	0-05-1761	FL
3	251E00000X	Home Health Agency	P06000053181	FL
4	251S00000X	Community/Behavioral Health Agency		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144367418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A GREAT LIFE SERVICES INC

Provider Business Mailing Address
First Line	:	15031 PERDIDO DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-5216
Country	:	US
Telephone Number	:	407-702-5258
Fax Number	:	407-382-0659

Provider Business Practice Location Address
First Line	:	1150 S SEMORAN BLVD STE A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1424
Country	:	US
Telephone Number	:	407-704-7811
Fax Number	:	407-382-0659

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JANERA ECHEVARRIA
Credential	:	LMHC, BCABA
Telephone Number	:	407-702-5258

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	09/12/2018

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Directions to “A GREAT LIFE SERVICES INC ” Practice Location

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