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NPI Code Detail

MEDICARE: CHANGE ACADEMY AT LAKE OF THE OZARKS

MEDICARE: CHANGE ACADEMY AT LAKE OF THE OZARKS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number : 1528714557
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHANGE ACADEMY AT LAKE OF THE OZARKS
Provider Business Mailing Address
First Line : 5500 MING AVE STE 410
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-4631
Country : US
Telephone Number : 661-622-4132
Fax Number :
Provider Business Practice Location Address
First Line : 9705 LOST PRAIRIE RD
Second Line :
City : MARION
State : MT
Zip : 59925-9844
Country : US
Telephone Number : 406-858-2339
Fax Number : 406-858-2356
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : SHARNELL SPENCER
Credential :
Telephone Number : 661-239-6923
Provider Enumeration Date : 02/28/2022
Last Update Date : 05/21/2025

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Practice Location Address:
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1760662639 — JOHN A MCKINNON M.D.
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1184806432 — MONTANA ACADEMY, INCORPORATED
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1477859932 — CYNTHIA FREEMAN R.N.
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1881442333 — CHANGE ACADEMY AT LAKE OF THE OZARKS
Practice Location Address:
9705 LOST PRAIRIE RD
MARION, MT
59925-9844
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Practice Fax:

Directions to “CHANGE ACADEMY AT LAKE OF THE OZARKS ” Practice Location

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