# INNERCHANGE LAKE HOUSE ACADEMY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** INNERCHANGE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1700234929
- **Legal business name:** INNERCHANGE
- **Authorized official:** HEATHER BLACK (INSURANCE SPECIALIST)
- **Authorized official phone:** (435) 229-5498

## Contact information

- **Practice address:** 447 LILLY PAD LN, FLAT ROCK, NC 28731-9503
- **Practice address phone:** (435) 229-5498
- **Mailing address:** 86 N UNIVERSITY AVE, \#450, PROVO, UT 84601-4420
- **Mailing address phone:** (435) 229-5498

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | NULL | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | — | Yes |

## Other

- **Enumeration date:** 05/27/2016
- **Last updated:** 05/27/2016