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	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	679488	OTHER	PTAN

General Provider Information

NPI Number	:	1689875411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCARE COMMUNITY LIVING CORPORATION - TEXAS

Provider Business Mailing Address
First Line	:	9901 LINN STATION RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3808
Country	:	US
Telephone Number	:	800-866-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	6771 CAMP BOWIE BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76116-7112
Country	:	US
Telephone Number	:	817-263-8840
Fax Number	:

Authorized Official
Title or Position	:	PARALEGAL
Name	:	MS. MARY A PANK
Credential	:
Telephone Number	:	502-420-2666

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	05/09/2016

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