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Change Academy at Lake of the Ozarks

Organization Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Benton, TN

NPI 1962005108 · NPPES record last updated May 21, 2025

Key facts

NPI
1962005108
Entity type
Organization (NPI type 2)
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
Legal business name
CHANGE ACADEMY AT LAKE OF THE OZARKS
Practice address
5842 Highway 30
Benton, TN 37307-4734
Phone
(505) 205-5819
NPI assigned
Nov 19, 2020
Organization subpart
Yes
Parent organization (as reported)
CHANGE ACADEMY AT LAKE OF THE OZARKS, LLC

Authorized official

Name
Sharnell Spencer
Title
Credentialing Manager
Phone
(661) 239-6923

Corporate family (same tax ID) 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

National Provider Directory

Tax ID family
Change Academy at Lake of the Ozarks (39 organizations share this tax ID)
Part of
Change Academy at Lake of the Ozarks

Locations

5842 Highway 30
Benton, TN 37307
Phone (423) 375-4173

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Yes

Addresses

Primary practice location

5842 Highway 30
Benton, TN 37307-4734

Mailing address

5500 Ming Ave Ste 410
Bakersfield, CA 93309-4631

Other names

  • Embark at the Forge Other name

Other providers in Benton, TN

All providers in Benton, TN · Emotionally Disturbed Childrens' Residential Treatment Facility in Tennessee

Sources for this page

Verify at the official NPI Registry.