MEDICARE: EDUCARE COMMUNITY LIVING CORPORATION - TEXAS

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

General Provider Information

NPI Number	:	1285299636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCARE COMMUNITY LIVING CORPORATION - TEXAS

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY STE 400
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-5186
Country	:	US
Telephone Number	:	502-394-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6647 CADES CV
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-2238
Country	:	US
Telephone Number	:	502-394-2100
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT
Name	:	MR. TIMOTHY WHOBREY
Credential	:
Telephone Number	:	502-630-7249

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	02/11/2021

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