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NPI Code Detail

MEDICARE: EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST

MEDICARE: EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST
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
1315P00000XIntellectual Disabilities Intermediate Care FacilityTX

General Provider Information

NPI Number : 1871918417
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST
Provider Business Mailing Address
First Line : 9901 LINN STATION RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-3808
Country : US
Telephone Number : 502-394-2100
Fax Number :
Provider Business Practice Location Address
First Line : 7418 ANTOINE DR
Second Line :
City : HOUSTON
State : TX
Zip : 77088-6707
Country : US
Telephone Number : 502-394-2100
Fax Number :
Authorized Official
Title or Position : ASSOC. GEN. COUNSEL/PRIVACY OFFICER
Name : MS. DEENA G. OMBRES
Credential :
Telephone Number : 502-394-2100
Provider Enumeration Date : 02/19/2014
Last Update Date : 02/19/2014

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Directions to “EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST ” Practice Location

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