Provider Demographics
NPI:1932617859
Name:LAKESHA N. RICHARDS
Entity Type:Organization
Organization Name:LAKESHA N. RICHARDS
Other - Org Name:MIRACLE ANGEL SUPPORTIVE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-580-5933
Mailing Address - Street 1:5230 GOLD TREE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1772
Mailing Address - Country:US
Mailing Address - Phone:407-580-5933
Mailing Address - Fax:321-445-5468
Practice Address - Street 1:5230 GOLD TREE CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1772
Practice Address - Country:US
Practice Address - Phone:407-580-5933
Practice Address - Fax:321-445-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020694800Medicaid