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General NPI Number Information
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NPI Number | 1073634606
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Entity Type | Organization
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Legal Business Name | EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 5706 PINEWILDE DR
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City | HOUSTON
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State | TX
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Zip | 77066-2322
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Country | US
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Telephone | 281-580-4103
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Fax |
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Provider Business Mailing Address
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Address Line | 805 N WHITTINGTON PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40222-7101
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Country | US
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Telephone | 502-394-2100
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT SPECIALIST
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Name | DASIA PENDLETON
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Credential |
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Telephone | 502-630-7494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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