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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