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CHANGE ACADEMY AT LAKE OF THE OZARKS NPI 1962005108


NPI Information

NPI: 1962005108
Provider Name: CHANGE ACADEMY AT LAKE OF THE OZARKS

Other Name: EMBARK AT THE FORGE

Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization
Address:
5842 HIGHWAY 30
BENTON, TN
ZIP 37307
Phone: (505) 205-5819
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CHANGE ACADEMY AT LAKE OF THE OZARKS is a residential treatment facility emotionally disturbed children in Benton, TN. 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 1962005108. The provider is registered as an organization entity type.
The provider Other Name Is Embark At The Forge.

The provider's business location address is:

5842 HIGHWAY 30
BENTON, TN
ZIP 37307-734
Phone: (505) 205-5819

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 11/19/2020 and was last updated on 11/29/2023.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1322D00000XResidential Treatment Facility, Emotionally Disturbed ChildrenYes

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: 5/5/2024

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