MEDICARE: MEDICAL HOME ALLIANCE LLC

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1285163477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL HOME ALLIANCE LLC

Provider Business Mailing Address
First Line	:	6675 WESTWOOD BLVD STE 475
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-6027
Country	:	US
Telephone Number	:	407-845-0330
Fax Number	:	888-972-1752

Provider Business Practice Location Address
First Line	:	431 W OAK ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-6627
Country	:	US
Telephone Number	:	407-845-0330
Fax Number	:	888-972-1752

Authorized Official
Title or Position	:	COO
Name	:	MRS. PATRICIA PICHARDO
Credential	:
Telephone Number	:	407-845-0330

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	06/29/2017

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Directions to “MEDICAL HOME ALLIANCE LLC ” Practice Location

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