# CHANGE ACADEMY LAKE OZARK

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

## Provider details

- **NPI number:** 1528469772
- **Authorized official:** DENISE HAGEMANN (OTR/L)
- **Authorized official phone:** (573) 552-8007

## Contact information

- **Practice address:** 130 CALO LN, LAKE OZARK, MO 65049-9208
- **Practice address phone:** (573) 365-2221
- **Practice address fax:** (573) 365-2224
- **Mailing address:** 130 CALO LN, LAKE OZARK, MO 65049-9208
- **Mailing address phone:** (573) 365-2221
- **Mailing address fax:** (573) 365-2224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 016604 | MO | — |
| 252Y00000X | Early Intervention Provider Agency | 016604 | MO | — |
| 261Q00000X | Clinic/Center | 016604 | MO | Yes |
| 305R00000X | Preferred Provider Organization | 016604 | MO | — |

## Other

- **Enumeration date:** 09/08/2014
- **Last updated:** 05/22/2015