MEDICARE: ALLIANCE AWARENESS CENTER 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center		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

General Provider Information

NPI Number	:	1669836995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE AWARENESS CENTER INC.

Provider Business Mailing Address
First Line	:	390 N ORANGE AVE
Second Line	:	SUITE 2300
City	:	ORLANDO
State	:	FL
Zip	:	32801-1640
Country	:	US
Telephone Number	:	877-646-3374
Fax Number	:	321-234-9267

Provider Business Practice Location Address
First Line	:	390 N ORANGE AVE
Second Line	:	SUITE 2300
City	:	ORLANDO
State	:	FL
Zip	:	32801-1640
Country	:	US
Telephone Number	:	877-646-3374
Fax Number	:	321-234-9267

Authorized Official
Title or Position	:	CEO/OWNER/FOUNDER
Name	:	MR. THEODORE ODEM JR.
Credential	:
Telephone Number	:	877-646-3374

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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