Provider Demographics
NPI:1912399155
Name:ALLIANCE AWARENESS CENTER
Entity Type:Organization
Organization Name:ALLIANCE AWARENESS CENTER
Other - Org Name:ALLIANCE AWARENESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
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:BS
Authorized Official - Phone:407-409-5791
Mailing Address - Street 1:618 E SOUTH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2986
Mailing Address - Country:US
Mailing Address - Phone:407-409-5791
Mailing Address - Fax:321-234-9267
Practice Address - Street 1:618 E SOUTH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2986
Practice Address - Country:US
Practice Address - Phone:407-409-5791
Practice Address - Fax:321-234-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013086200Medicaid