Organization
CHANGE ACADEMY LAKE OF THE OZARKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL KOEHLER MA (RECREATION THERAPY DIRECTOR)
(866) 753-1374
Entity
Organization
Contact information
Practice address
130 CALO LN, LAKE OZARK, MO 65049-9208
(573) 200-1605
Mailing address
130 CALO LN, LAKE OZARK, MO 65049-9208
(573) 200-1605
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/02/2012
Last updated
08/02/2012
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