MEDICARE: EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST

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		TX

General Provider Information

NPI Number	:	1023433679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST

Provider Business Mailing Address
First Line	:	9901 LINN STATION RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3808
Country	:	US
Telephone Number	:	502-394-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8002 FAWN TERRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2723
Country	:	US
Telephone Number	:	502-394-2100
Fax Number	:

Authorized Official
Title or Position	:	ASSOC. GEN. COUNSEL/PRIVACY OFFICER
Name	:	MS. DEENA G. OMBRES
Credential	:
Telephone Number	:	502-394-2100

Provider Enumeration Date	:	02/19/2014
Last Update Date	:	02/19/2014

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