MEDICARE: EDUCARE COMMUNITY LIVING CORPORATION - NEVADA

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

General Provider Information

NPI Number	:	1427252741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCARE COMMUNITY LIVING CORPORATION - NEVADA

Provider Business Mailing Address
First Line	:	9901 LINN STATION RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3808
Country	:	US
Telephone Number	:	800-866-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	3811 W CHARLESTON BLVD
Second Line	:	SUITE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1846
Country	:	US
Telephone Number	:	702-880-0961
Fax Number	:

Authorized Official
Title or Position	:	PRIVACY OFFICER
Name	:	MS. DEENA OMBRES
Credential	:
Telephone Number	:	502-394-2387

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/22/2020

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