Provider Demographics
NPI:1114414463
Name:ALTERARE ADVANTAGE LLC
Entity type:Organization
Organization Name:ALTERARE ADVANTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAZZMYN
Authorized Official - Middle Name:ALYSSIA-MARIE
Authorized Official - Last Name:IGLESIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS BCBA
Authorized Official - Phone:407-780-0177
Mailing Address - Street 1:2911 STONE GLEN WAY APT 107
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1784
Mailing Address - Country:US
Mailing Address - Phone:407-780-0177
Mailing Address - Fax:
Practice Address - Street 1:151 N. MAITLAND AVENUE
Practice Address - Street 2:948514
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-3275
Practice Address - Country:US
Practice Address - Phone:407-780-0177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-21
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health