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CHANGE ACADEMY AT LAKE OF THE OZARKS
NPI 1225645674
Residential Treatment Facility, Emotionally Disturbed Children in Benton, TN

Active since September 29, 2020CLIA 44D2216110 · Waiver
5842 HIGHWAY 30, BENTON, TN 37307(505) 205-5819 Get Directions Write a Review

NPPES record last updated: May 21, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 21, 2025, Jun 20, 2023, Apr 3, 2023 and 1 more (4 updates tracked since 2020).

About Change Academy At Lake Of The Ozarks NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHANGE ACADEMY AT LAKE OF THE OZARKS (NPI 1225645674) is a healthcare organization registered as a residential treatment facility, emotionally disturbed children in Benton, Tennessee and active in the NPI registry since September 2020. The organization holds a CLIA Waiver certificate valid through March 8, 2027 and lists Sharnell Spencer, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1225645674
Entity TypeOrganization
Primary Taxonomy322D00000X
Legal Business NameCHANGE ACADEMY AT LAKE OF THE OZARKS
Location Address5842 HIGHWAY 30Benton, TN 37307-4734
Mailing Address5500 Ming Ave Ste 410Bakersfield, CA 93309-4631 · (661) 622-4132
Phone(505) 205-5819
Organization SubpartYes
Authorized OfficialSharnell SpencerCredentialing Manager · (661) 239-6923
Enumeration DateSeptember 29, 2020
Last NPPES UpdateMay 21, 20254 updates tracked since enumeration
NPPES CertifiedMay 21, 2025
✔ NPI 1225645674 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyResidential Treatment Facility, Emotionally Disturbed ChildrenResidential Treatment Facilities
Taxonomy Code322D00000X
Definition
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.
5842 HIGHWAY 30, Benton, TN 37307
Open in Google Maps ↗

Other Names 1

Other NameThe Forge School

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D2216110

Change Academy At Lake Of The Ozarks, LLC Dba Embark Behavioral Health · Benton, TN
Active · expires Mar 8, 2027
CLIA Number44D2216110
Laboratory TypeMental Health Res Trtmt
Certificate Effective DateMarch 9, 2025
Certificate Expiration DateMarch 8, 2027
Laboratory DirectorCassandra Simms
Laboratory Phone(423) 405-6345
Laboratory LocationChange Academy At Lake Of The Ozarks, LLC Dba Embark Behavioral Health5842 Highway 30, Benton, TN 37307
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

IAN DEVILLE
Social Worker (Clinical)
5842 HIGHWAY 30
BENTON, TN 37307
Polk County (423) 283-5533
MRS. ROBIN DENISE BLACKBURN RN
Registered Nurse
5842 HIGHWAY 30
BENTON, TN 37307
Polk County (423) 421-6751
MAYA PALIARO
Counselor (Mental Health)
5842 HIGHWAY 30
BENTON, TN 37307
Polk County (423) 375-4173
MS. NATALIE SUSAN POWELL RN
Registered Nurse
5842 HIGHWAY 30
BENTON, TN 37307
Polk County (423) 599-5796
DAPHNE HARGIS
Counselor (Professional)
5842 HIGHWAY 30
BENTON, TN 37307
Polk County (423) 375-4173
LORA M BROWN RN
Registered Nurse (General Practice)
5842 HIGHWAY 30
BENTON, TN 37307
Polk County (423) 375-4173
KATHERINE H BRANHAM LPN
Licensed Practical Nurse
5842 HIGHWAY 30
BENTON, TN 37307
Polk County (423) 375-4173
MR. ROBERT LOUIS STEWART CNMT
Nuclear Medicine
5842 HIGHWAY 30
BENTON, TN 37307
Polk County (423) 333-5268

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Change Academy At Lake Of The Ozarks's NPI number?

The NPI number for Change Academy At Lake Of The Ozarks is 1225645674. It was assigned to this organization in the NPPES registry on September 29, 2020. The provider is also known as The Forge School.

Where is Change Academy At Lake Of The Ozarks located?

Change Academy At Lake Of The Ozarks is located at 5842 Highway 30, Benton, TN 37307. The listed phone number is (505) 205-5819.

What is Change Academy At Lake Of The Ozarks's specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Emotionally Disturbed Children with taxonomy code 322D00000X.

Does Change Academy At Lake Of The Ozarks hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D2216110) is associated with this NPI, valid through March 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Change Academy At Lake Of The Ozarks was last updated on May 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.