Provider Demographics
NPI:1053974394
Name:ACADEMY HOME CARE SERVICES, LLC
Entity type:Organization
Organization Name:ACADEMY HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMBODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-527-1770
Mailing Address - Street 1:355 OZARK TRAIL DR STE 2
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2164
Mailing Address - Country:US
Mailing Address - Phone:636-527-1770
Mailing Address - Fax:636-527-1796
Practice Address - Street 1:355 OZARK TRAIL DR STE 2
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2164
Practice Address - Country:US
Practice Address - Phone:636-527-1770
Practice Address - Fax:636-527-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOM266035500Medicaid