# CHANGE ACADEMY LAKE OF THE OZARKS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134475635
- **Authorized official:** MR. MICHAEL KOEHLER MA (RECREATION THERAPY DIRECTOR)
- **Authorized official phone:** (866) 753-1374

## Contact information

- **Practice address:** 130 CALO LN, LAKE OZARK, MO 65049-9208
- **Practice address phone:** (573) 200-1605
- **Mailing address:** 130 CALO LN, LAKE OZARK, MO 65049-9208
- **Mailing address phone:** (573) 200-1605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 08/02/2012
- **Last updated:** 08/02/2012