# CHANGE ACADEMY AT LAKE OF THE OZARKS

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

## Provider details

- **NPI number:** 1316130784
- **Authorized official:** SHARNELL SPENCER (CREDENTIALING MANAGER)
- **Authorized official phone:** (661) 239-6923

## Contact information

- **Practice address:** 130 CALO LANE, LAKE OZARK, MO 65049
- **Practice address phone:** (573) 365-2221
- **Practice address fax:** (573) 365-2224
- **Mailing address:** 5500 MING AVE STE 410, BAKERSFIELD, CA 93309-4631
- **Mailing address phone:** (661) 622-4132
- **Mailing address fax:** (573) 365-2224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |
| 323P00000X | Psychiatric Residential Treatment Facility | 105270 | MO | — |

## Other

- **Enumeration date:** 08/20/2007
- **Last updated:** 05/21/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 179084125 | — | AR |
| 05 | — | 3404547 | — | NC |