AWESOME ANGELS OF CHANGE LLC (NPI# 1497229926) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497229926 |
| Entity Type | Organization |
| Organization Name | AWESOME ANGELS OF CHANGE LLC |
| Practice Address |
3909 Sandhill Crane Dr Lakeland FL 33811-1862 |
| Practice Telephone | 8636175840 |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2019-01-17 |
| Authorized Official Name | SHACOYA MONTGOMERY (CEO) |
| Authorized Official Telephone | 8636175840 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| AAC | Former Legal Business Name - Organization |
| Street Address |
3909 SANDHILL CRANE DR |
| City | LAKELAND |
| State | FL |
| Zip Code | 33811-1862 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316416381 | Shacoya Montgomery | Clinic/Center | 3909 Sandhill Crane Dr, Lakeland, FL 33811-1862 | 2018-11-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952910200 | Darielle Shanette Berrian | Assisted Living Facility | 1548 Georgetown Dr, Lakeland, FL 33811 | 2020-07-23 |
| 1760991012 | Gregory Clark | Driver | 1091 Old South Dr, Lakeland, FL 33811 | 2017-09-28 |
| 1356870703 | Jeanette Michelle Edmonds | Psychologist | 4231 S. Pipkin Rd., Building 2 - Mental Health/behavioral Sciences, Lakeland, FL 33811 | 2017-06-08 |
| 1932353406 | Monique L Lisowski | Dietitian, Registered | 4231 South Pipkin Road, Lakeland, FL 33811 | 2008-11-11 |
| 1306987029 | Lifesavers Home Respiratory, Inc. | Durable Medical Equipment & Medical Supplies | 2525 Drane Field Rd, Suite 14, Lakeland, FL 33811 | 2007-02-08 |
| 1518010305 | Kirk Randall Smith | Nurse Practitioner | 1475 Airport Road, Lakeland, FL 33811 | 2007-01-18 |
| 1578568176 | Southeastern Medical Supply Inc | Durable Medical Equipment & Medical Supplies | 3615 Century Blvd, Unit #1, Lakeland, FL 33811 | 2005-06-20 |
| 1225279318 | Affordable Transport Inc. | Non-emergency Medical Transport (VAN) | 3706 Dmg Dr, Lakeland, FL 33811-1043 | 2009-03-18 |
| 1457747875 | Candace Borders | Physical Therapy Assistant | 3225 Thoroughbred Loop N, Lakeland, FL 33811-1078 | 2015-04-13 |
| 1962849729 | Angelica Monteverde | Counselor | 3121 Filly Ln, Lakeland, FL 33811-1080 | 2013-06-03 |
| Find all providers in zip 33811 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366071995 | Better Quest Healthcare Agency | Clinic/Center | 8083 Darlington Cir, Lakeland, FL 33809-6841 | 2020-04-06 |
| 1033753876 | Sanergy Administrative and Home Care Services | Clinic/Center | 722 Saratoga Ave, Lakeland, FL 33815-1279 | 2019-11-05 |
| 1962044602 | Helping Everyone Spiritually LLC | Clinic/Center | 7225 Twin Cedar Ln, Lakeland, FL 33810-2183 | 2019-10-15 |
| 1831746593 | Bobbie Dashercare LLC | Clinic/Center | 4006 Golf Village Loop Apt 2, Lakeland, FL 33809-4056 | 2019-08-19 |
| 1316416381 | Shacoya Montgomery | Clinic/Center | 3909 Sandhill Crane Dr, Lakeland, FL 33811-1862 | 2018-11-19 |
| 1306323340 | Sandrene Smart | Clinic/Center | 625 Commerce Dr. (suite 103), Lakeland, FL 33813 | 2018-07-23 |
| 1629577382 | Dane Anthony Jones | Clinic/Center | 7833 Manor Dr, Lakeland, FL 33810-1380 | 2018-02-08 |
| 1235650029 | Lynn Tatyana Joseph | Clinic/Center | 921 E Parker St Ste 4, Lakeland, FL 33801-1901 | 2017-06-30 |
| 1730252479 | South Georgia Csb | Clinic/Center | 321 W Brantley, Lakeland, GA 31635 | 2006-11-17 |
| 1376190025 | C&g's Grace Place LLC | Clinic/Center | 6763 Krenson Oaks Cir, Lakeland, FL 33810-2157 | 2019-08-19 |
| Find all providers in LAKELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.