| Change Academy At Lake Of The Ozarks | |
|
4000 Civic Center Dr Ste 102 San Rafael CA 94903-4171 | |
| (415) 578-5727 | |
| Not Available |
| Full Name | Change Academy At Lake Of The Ozarks |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4000 Civic Center Dr Ste 102, San Rafael, California |
| Authorized Official Name and Position | Laura J Brown (VP OF REVENUE CYCLE MANAGEMENT) |
| Authorized Official Contact | 6618294060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Change Academy At Lake Of The Ozarks 5500 Ming Ave Ste 410 Bakersfield CA 93309-4631 Ph: (661) 622-4132 | Change Academy At Lake Of The Ozarks 4000 Civic Center Dr Ste 102 San Rafael CA 94903-4171 Ph: (415) 578-5727 |
| NPI Number | 1225722093 |
|---|---|
| Provider Enumeration Date | 06/05/2023 |
| Last Update Date | 06/05/2023 |
| Certification Date | 06/05/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225722093 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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