Organization
AWESOME ANGELS OF CHANGE LLC
Active
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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