Organization · Type 2 NPI

Change Academy at Lake of the Ozarks

Emotionally Disturbed Childrens' Residential Treatment Facility · Benton, TN

NPI number 1962005108 Active

Practice location

5842 Highway 30
Benton, TN 37307-4734

Call (505) 205-5819 Map

Mailing address

5500 Ming Ave Ste 410
Bakersfield, CA 93309-4631

Specialties and licenses

Taxonomy	Code	License
Mental Illness Community Based Residential Treatment Facility	320800000X	None listed
Emotionally Disturbed Childrens' Residential Treatment Facility Primary	322D00000X	None listed

Emotionally Disturbed Childrens' Residential Treatment Facility: 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.

11 other providers at this address

Other emotionally disturbed childrens' residential treatment facility providers in Benton

Change Academy at Lake of the OzarksEmotionally Disturbed Childrens' Residential Treatment Facility Benton, TN NPI 1225645674

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NPI record

NPI: 1962005108
Entity type: Organization (Type 2)
Issued: Nov 19, 2020
Last updated: Oct 29, 2026
Status: Active
Subpart: Yes of Change Academy at Lake of the Ozarks, LLC

Other names

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Embark at the Forge · other name

Authorized official

Sharnell Spencer
Credentialing Manager
(661) 239-6923

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1962005108

Change Academy at Lake of the Ozarks's National Provider Identifier is 1962005108, issued on Nov 19, 2020. The primary taxonomy on file is Emotionally Disturbed Childrens' Residential Treatment Facility (322D00000X), and the practice location is in Benton, TN. The record was last updated on Oct 29, 2026.