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CHANGE ACADEMY AT LAKE OF THE OZARKS NPI 1316130784


NPI Information

NPI: 1316130784
Provider Name: CHANGE ACADEMY AT LAKE OF THE OZARKS
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization
Address:
130 CALO LANE
LAKE OZARK, MO
ZIP 65049
Phone: (573) 365-2221
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CHANGE ACADEMY AT LAKE OF THE OZARKS is a residential treatment facility emotionally disturbed children in Lake Ozark, MO. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. CHANGE ACADEMY AT LAKE OF THE OZARKS NPI is 1316130784. The provider is registered as an organization entity type.

The provider's business location address is:

130 CALO LANE
LAKE OZARK, MO
ZIP 65049
Phone: (573) 365-2221
Fax: (573) 365-2224

The provider's authorized official is Laura J Brown .
The authorized official title is Vp Of Revenue Cycle Management and has the following contact phone number (661) 829-4060.

The enumeration date for this NPI number is 8/20/2007 and was last updated on 6/20/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1323P00000XPsychiatric Residential Treatment Facility105270MISSOURINo
2322D00000XResidential Treatment Facility, Emotionally Disturbed ChildrenYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13404547MEDICAIDNORTH CAROLINA
2179084125MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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