Organization
AWESOME ANGELS OF CHANGE LLC
Active
Other names
AAC
Organization subpart
No
Provider details
NPI number
Authorized official
SHACOYA MONTGOMERY (CEO)
(863) 617-5840
Entity
Organization
Contact information
Practice address
3909 SANDHILL CRANE DR, LAKELAND, FL 33811-1862
(863) 617-5840
Mailing address
3909 SANDHILL CRANE DR, LAKELAND, FL 33811-1862
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
01/17/2019
Last updated
01/17/2019
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