Change Academy At Lake Of The Ozarks
Residential Treatment Facility, Emotionally Disturbed Children in Benton, TN. Organization (NPI-2).
NPI number1962005108
StatusActive
Last updated in NPPESOct 29, 2026
Details
- NPI
- 1962005108
- Entity type
- Organization (NPI-2)
- Legal business name
- Change Academy At Lake Of The Ozarks
- Organization subpart
- Yes
- Enumeration date
- Nov 19, 2020
- Certification date
- Oct 29, 2026
- Last updated
- Oct 29, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | – | – | Yes |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | – | – |
Other names
- Embark At The Forge (Other Name)
Practice location
5842 Highway 30Benton, TN 37307-4734
Phone 505-205-5819
Mailing address
5500 Ming Ave Ste 410Bakersfield, CA 93309-4631
Authorized official
Sharnell Spencer
Credentialing Manager
6612396923
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