MEDICARE: EDUCARE COMM LIVING CORP 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	:	1558482539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCARE COMM LIVING CORP TEXAS

Provider Business Mailing Address
First Line	:	10140 LINN STATION RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3813
Country	:	US
Telephone Number	:	800-866-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	7206 RIDGE OAK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-5325
Country	:	US
Telephone Number	:	713-466-3138
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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Directions to “EDUCARE COMM LIVING CORP TEXAS ” Practice Location

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