# INNERCHANGE LAKE HOUSE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake House Academy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215524756
- **Authorized official:** MRS. LAURA J BROWN (VP OF REVENUE CYCLE MANAGEMENT)
- **Authorized official phone:** (661) 829-4060

## Contact information

- **Practice address:** 447 LILY PAD LN, FLAT ROCK, NC 28731-9503
- **Practice address phone:** (435) 229-5498
- **Mailing address:** 5500 MING AVE STE 410, BAKERSFIELD, CA 93309-4631
- **Mailing address phone:** (661) 622-4132

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | — | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 12/30/2020
- **Last updated:** 11/29/2023