Healthcare Provider Details

I. General information

NPI: 1063473460
Provider Name (Legal Business Name): EDUCARE COMMUNITY LIVING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 W CHARLESTON BLVD 210
LAS VEGAS NV
89102-1846
US

IV. Provider business mailing address

3811 W CHARLESTON BLVD 210
LAS VEGAS NV
89102-1846
US

V. Phone/Fax

Practice location:
  • Phone: 702-880-0961
  • Fax: 702-880-0965
Mailing address:
  • Phone: 702-880-0961
  • Fax: 702-880-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number StateNV

VIII. Authorized Official

Name: DAVE RHODES
Title or Position: REGIONAL V.P.
Credential:
Phone: 303-702-0056