Healthcare Provider Details

I. General information

NPI: 1730764689
Provider Name (Legal Business Name): EDUCARE COMMUNITY LIVING CORPORATION - NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 E FLAMINGO RD STE 110
LAS VEGAS NV
89119-5163
US

IV. Provider business mailing address

805 N WHITTINGTON PKWY
LOUISVILLE KY
40222-7101
US

V. Phone/Fax

Practice location:
  • Phone: 702-880-0961
  • Fax:
Mailing address:
  • Phone: 502-394-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY WHOBREY
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 502-630-7249