CHANGE ACADEMY AT LAKE OF THE OZARKS (NPI# 1225645674) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225645674 |
| Entity Type | Organization |
| Organization Name | CHANGE ACADEMY AT LAKE OF THE OZARKS |
| Practice Address |
5842 Highway 30 Benton TN 37307-4734 |
| Mailing Address |
5500 Ming Ave Ste 265 Bakersfield CA 93309-4689 |
| Practice Telephone | 5052055819 |
| Mailing Telephone | 6618294060 |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-09-29 |
| Authorized Official Name | LAURA J BROWN (VICE PRESIDENT OF RCM) |
| Authorized Official Telephone | 6618294060 |
| Is Organization Subpart | Y |
| Parent Organization Name | CHANGE ACADEMY AT LAKE OF THE OZARKS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 323P00000X | Psychiatric Residential Treatment Facility | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| The Forge School | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659900835 | Change Academy At Lake of The Ozarks | Residential Treatment Facility, Emotionally Disturbed Children | 266 South Left Fork Hobble Creek Canyon Road, Springville, UT 84663 | 2020-04-08 |
| 1316130784 | Change Academy At Lake of The Ozarks | Psychiatric Residential Treatment Facility | 130 Calo Lane, Lake Ozark, MO 65049 | 2007-08-20 |
| 1902435399 | Change Academy At Lake of The Ozarks | Community/Behavioral Health | 7945 Macarthur Blvd Ste 214, Cabin John, MD 20818-1634 | 2020-04-07 |
| 1093280943 | Change Academy At Lake of The Ozarks | Residential Treatment Facility, Emotionally Disturbed Children | 130 Calo Ln, Lake Ozark, MO 65049-9208 | 2018-10-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Change Academy at Lake of the Ozarks | 130 Calo Lane, Lake Ozark, MO 65049 |
| Oregon Corporations, Companies and Business Names | CHANGE ACADEMY AT LAKE OF THE OZARKS, LLC | Po Box 1810, Lake Ozark, MO 65049 |
| Street Address |
5842 HIGHWAY 30 |
| City | BENTON |
| State | TN |
| Zip Code | 37307-4734 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538330485 | Caleb Sloan Rae | Physician Assistant | 126 Polk Street, Benton, TN 37307 | 2008-03-19 |
| 1104026087 | Christopher Alvin Patterson | Pharmacist | 6206 Hwy 411, Benton, TN 37307 | 2007-07-19 |
| 1053446450 | Jason Dewayne Nicholson | Dentist | 6151 Hwy 411, Benton, TN 37307 | 2007-02-23 |
| 1598825226 | Preferred Pharmacy, Inc | Durable Medical Equipment & Medical Supplies | 6206 Highway 411, Benton, TN 37307 | 2006-12-11 |
| 1306895784 | Joseph Matthew Gager | Physical Therapist | 6176 Highway 411, Benton, TN 37307 | 2006-05-10 |
| 1588721682 | Jerry D. Lowery | Pharmacist | 55 Main Street, Benton, TN 37307 | 2007-01-02 |
| 1457424194 | Rachel Mcclary Brewer | Pharmacist | 55 Main Street, Benton, TN 37307 | 2006-11-17 |
| 1780797035 | Aleksander Ivanovich Malakhov | Family Medicine | Highway 411 South, Benton, TN 37307-0308 | 2006-08-17 |
| 1386857381 | Ocoee Regional Health Corporation | Clinic/Center | 6784 Highway 411, Benton, TN 37307-0308 | 2007-05-07 |
| 1053757005 | Kimberli Booth | Massage Therapist | 217 Ward St, Benton, TN 37307-3054 | 2013-05-17 |
| Find all providers in zip 37307 | ||||
| Taxonomy Code | 323P00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Psychiatric Residential Treatment Facility |
| A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient’s surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary |
| Notes: Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053966747 | Youth Villages, Inc | Psychiatric Residential Treatment Facility | 7428 Memphis-arlington Rd, Memphis, TN 38135-3813 | 2019-08-08 |
| 1679127971 | Youth Villages, Inc. | Psychiatric Residential Treatment Facility | 7386 Memphis Arlington Rd, Memphis, TN 38135-1908 | 2019-07-25 |
| 1396215810 | Hanbleceya Nashville, LLC | Psychiatric Residential Treatment Facility | 300 35th Ave N, Nashville, TN 37209-3921 | 2018-11-27 |
| 1700332145 | Keysgroupholdings LLC | Psychiatric Residential Treatment Facility | 110 Westwood Pl, Suite 100, Brentwood, TN 37027-5075 | 2016-08-26 |
| 1144672411 | Woodridge Behavioral Care, LLC | Psychiatric Residential Treatment Facility | 162 Cude Ln, Madison, TN 37115-2202 | 2016-07-11 |
| 1144689001 | Onsite Partners, Inc. | Psychiatric Residential Treatment Facility | 1044 Old Highway 48 N, Cumberland Furnace, TN 37051-5000 | 2016-02-19 |
| 1811389158 | Ko Pest Control | Psychiatric Residential Treatment Facility | 3575 Hwy 138, Toone, TN 38381 | 2015-02-24 |
| 1124463849 | Frontier Health | Psychiatric Residential Treatment Facility | 210 Quary Rd, Johnson City, TN 37601-7580 | 2013-05-08 |
| 1063796431 | The Link Center, Inc. | Psychiatric Residential Treatment Facility | 6978 Lebanon Rd Ste F, Mount Juliet, TN 37122-7201 | 2011-10-04 |
| 1699054346 | Almost Home Inc | Psychiatric Residential Treatment Facility | 5507 Santa Monica St, Memphis, TN 38116-9233 | 2011-08-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.