Provider Demographics
NPI:1144367418
Name:A GREAT LIFE SERVICES INC
Entity type:Organization
Organization Name:A GREAT LIFE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANERA
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, BCABA
Authorized Official - Phone:407-702-5258
Mailing Address - Street 1:15031 PERDIDO DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5216
Mailing Address - Country:US
Mailing Address - Phone:407-702-5258
Mailing Address - Fax:407-382-0659
Practice Address - Street 1:1150 S SEMORAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1424
Practice Address - Country:US
Practice Address - Phone:407-704-7811
Practice Address - Fax:407-382-0659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC 10628101YM0800X
FL0-05-1761103K00000X
FLP06000053181251E00000X
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004774200Medicaid
FL691558202OtherMEDICAID PERSONAL CARE
FL691558296Medicaid
FL691558201OtherMEDICAID AGED/DISABLED ADULTS