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General NPI Number Information
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NPI Number | 1548414790
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Entity Type | Organization
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Legal Business Name | IMAGINE ACADEMY OF ESM
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 1008 S SPRING AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2520
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Country | US
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Telephone | 314-773-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 S SPRING AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2520
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Country | US
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Telephone | 314-773-4400
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Fax |
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Authorized Official
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Title or Position | PRINCIPLE K-5
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Name | ANGELE THIBODEAUX-BURNS
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Credential |
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Telephone | 314-773-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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