Healthcare Provider Details

I. General information

NPI: 1215090352
Provider Name (Legal Business Name): EDUCARE COMMUNITY LIVING CORPORATION - MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 METRO BLVD
MARYLAND HEIGHTS MO
63043-2417
US

IV. Provider business mailing address

9901 LINN STATION RD
LOUISVILLE KY
40223-3808
US

V. Phone/Fax

Practice location:
  • Phone: 314-994-3033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DEENA G OMBRES
Title or Position: ASSOC. GEN. COUNSEL/PRIVACY OFFICER
Credential:
Phone: 502-394-2387