MEDICARE: EDUCARE COMMUNITY LIVING CORPORATION - NEVADA

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	:	1295344430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCARE COMMUNITY LIVING CORPORATION - NEVADA

Provider Business Mailing Address
First Line	:	6600 FRANCE AVE S STE 350
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-1810
Country	:	US
Telephone Number	:	800-388-5150
Fax Number	:

Provider Business Practice Location Address
First Line	:	4575 W CAPOVILLA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-5044
Country	:	US
Telephone Number	:	702-880-0961
Fax Number	:

Authorized Official
Title or Position	:	VP & SR ASST GENERAL COUNSEL
Name	:	MARY PATRICIA RODENBERG-ROBERTS
Credential	:
Telephone Number	:	952-836-2234

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	04/27/2026

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