MEDICARE: EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073634762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7101
Country	:	US
Telephone Number	:	502-394-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2803 QUINCANNON LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-1603
Country	:	US
Telephone Number	:	713-690-3127
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANGIE MATTINGLY
Credential	:
Telephone Number	:	502-630-7138

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	06/18/2025

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