CHANGE ACADEMY AT LAKE OF THE OZARKS
NPI 1962005108
Residential Treatment Facility, Emotionally Disturbed Children in Benton, TN

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

The NPI number for Change Academy At Lake Of The Ozarks is 1962005108. It was assigned to this organization in the NPPES registry on November 19, 2020. The provider is also known as Embark at the Forge.

Q: 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.

Active since November 19, 2020

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, Jul 19, 2022 and 1 more (4 updates tracked since 2020).

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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 1962005108) is a healthcare organization registered as a residential treatment facility, emotionally disturbed children in Benton, Tennessee and active in the NPI registry since November 2020. The organization lists Sharnell Spencer, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1962005108

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

Phone(505) 205-5819

Organization SubpartYesParent: Change Academy At Lake Of The Ozarks, Llc

Authorized OfficialSharnell SpencerCredentialing Manager · (661) 239-6923

Enumeration DateNovember 19, 2020

Last NPPES UpdateMay 21, 20254 updates tracked since enumeration

NPPES CertifiedMay 21, 2025

✔ NPI 1962005108 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

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Other Names 1

Other NameEmbark At The Forge

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)