MEDICARE: EDUCARE COMMUNITY LIVING LIMITED PARTNERSHIP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548382310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCARE COMMUNITY LIVING LIMITED PARTNERSHIP

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7101
Country	:	US
Telephone Number	:	800-866-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	5724 WINIFRED DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76133-2504
Country	:	US
Telephone Number	:	817-292-5398
Fax Number	:

Authorized Official
Title or Position	:	PRIVACY OFFICER
Name	:	DEENA OMBRES
Credential	:
Telephone Number	:	502-394-2387

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	02/29/2024

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