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	:	1316374150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCARE COMMUNITY LIVING CORPORATION - TEXAS

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7101
Country	:	US
Telephone Number	:	502-394-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	7906 APPOMATTOX DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-6902
Country	:	US
Telephone Number	:	512-448-1194
Fax Number	:

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

Provider Enumeration Date	:	10/10/2013
Last Update Date	:	02/09/2021

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