Provider Demographics
NPI:1669836995
Name:ALLIANCE AWARENESS CENTER INC.
Entity Type:Organization
Organization Name:ALLIANCE AWARENESS CENTER INC.
Other - Org Name:ALLIANCE AWARENESS CENTER INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:877-646-3374
Mailing Address - Street 1:390 N ORANGE AVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1640
Mailing Address - Country:US
Mailing Address - Phone:877-646-3374
Mailing Address - Fax:321-234-9267
Practice Address - Street 1:390 N ORANGE AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1640
Practice Address - Country:US
Practice Address - Phone:877-646-3374
Practice Address - Fax:321-234-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1760891493Medicaid