Basic Information
| Provider Information | |||||||||
| NPI: | 1033310875 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EDUCARE COMMUNITY LIVING CORPORATION - TEXAS | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9901 LINN STATION RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402233808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008660860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 S MO PAC EXPY | ||||||||
| Address2: | BLDG II SUITE 450 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787465776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124982705 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | OMBRES | ||||||||
| AuthorizedOfficialFirstName: | DEENA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRIVACY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5023942387 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1003612 | 05 | TX | MEDICAID | 1003620 | 05 | TX | MEDICAID | 1003611 | 05 | TX | MEDICAID | 1003615 | 05 | TX | MEDICAID | 1003174 | 05 | TX | MEDICAID | 1003613 | 05 | TX | MEDICAID | 1003619 | 05 | TX | MEDICAID | 10036096114 | 05 | TX | MEDICAID | 1003617 | 05 | TX | MEDICAID | 1003618 | 05 | TX | MEDICAID | 1003175 | 05 | TX | MEDICAID | 1003610 | 05 | TX | MEDICAID | 1003176 | 05 | TX | MEDICAID | 1003178 | 05 | TX | MEDICAID | 1003609 | 05 | TX | MEDICAID | 1003173 | 05 | TX | MEDICAID | 1003177 | 05 | TX | MEDICAID | 1003616 | 05 | TX | MEDICAID | 10036176103 | 05 | TX | MEDICAID |