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Organization
CHANGE ACADEMY AT LAKE OF THE OZARKS
Active
Organization
CHANGE ACADEMY AT LAKE OF THE OZARKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARNELL SPENCER (CREDENTIALING MANAGER)
(661) 239-6923
Entity
Organization
Contact information
Practice address
130 CALO LANE, LAKE OZARK, MO 65049
(573) 365-2221
(573) 365-2224
Mailing address
5500 MING AVE STE 410, BAKERSFIELD, CA 93309-4631
(661) 622-4132
(573) 365-2224
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
105270
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179084125
—
AR
05
—
3404547
—
NC
Enumeration date
08/20/2007
Last updated
05/21/2025
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