MEDICARE: ACE BEHAVIOR 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	103K00000X	Behavior Analyst

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

General Provider Information

NPI Number	:	1528691649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACE BEHAVIOR ALLIANCE LLC

Provider Business Mailing Address
First Line	:	1969 S ALAFAYA TRL # 346
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-8732
Country	:	US
Telephone Number	:	813-388-8188
Fax Number	:

Provider Business Practice Location Address
First Line	:	13645 E COLONIAL DR APT D390
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-4931
Country	:	US
Telephone Number	:	813-388-8188
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LESLIE SELINA SANDOVAL
Credential	:	BCBA
Telephone Number	:	407-931-6212

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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