Healthcare Provider Details

I. General information

NPI: 1952205692
Provider Name (Legal Business Name): BE THE CHANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W 26TH ST
CHEYENNE WY
82001-3038
US

IV. Provider business mailing address

218 W 26TH ST
CHEYENNE WY
82001-3038
US

V. Phone/Fax

Practice location:
  • Phone: 307-274-0646
  • Fax:
Mailing address:
  • Phone: 307-274-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. KENDRA JEAN POLEDNA
Title or Position: OWNER
Credential:
Phone: 307-274-0646