NPI age
1 years
Enumerated 2024-10-02
● Active Type 2 · Organization
Subpart
Change Academy At Lake Of The Ozarks
Change Academy At Lake Of The Ozarks is 1 of 326 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Spencer
Credentialing Manager
Last NPPES update
2025-05-21
Source: monthly bulk 2026-05
How this organization compares
Across 326 active clinic/center providers in Idaho.
NPI age
1 years
↓ 4 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2024 → 2026
2024-10Enumerated in NPPES
2024
2026
Where they practice
Primary practice location
943 W Overland Rd Fl 1
Meridian, ID 836427618
Mailing address
5500 Ming Ave Ste 410
Bakersfield, CA 933094631
Authorized official
Sharnell Spencer
Credentialing Manager
📞 6612396923
Individual providers at this organization
1 individual provider on file at this primary practice address.
- Taylor Iverson Occupational Therapist NPI 1699629022
Specialties
-
Clinic/Center PrimaryDefinition to come...
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Embark Virtual at Idaho
-
Embark Virtual at Idaho
Practice context
Multi-provider organization. 1 individual provider on file at this primary address.
Subpart of Change Academy At Lake Of The Ozarks.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.