Organization
CHANGE ACADEMY AT LAKE OF THE OZARKS
Active
Parent organization
CHANGE ACADEMY AT LAKE OF THE OZARKS, LLC
Other names
Embark at the Forge
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHANGE ACADEMY AT LAKE OF THE OZARKS, LLC
Authorized official
SHARNELL SPENCER (CREDENTIALING MANAGER)
(661) 239-6923
Entity
Organization
Contact information
Practice address
5842 HIGHWAY 30, BENTON, TN 37307-4734
(505) 205-5819
Mailing address
5500 MING AVE STE 410, BAKERSFIELD, CA 93309-4631
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/19/2020
Last updated
05/21/2025
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