Provider Demographics
NPI:1033310875
Name:EDUCARE COMMUNITY LIVING CORPORATION - TEXAS
Entity Type:Organization
Organization Name:EDUCARE COMMUNITY LIVING CORPORATION - TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMBRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-394-2387
Mailing Address - Street 1:9901 LINN STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3808
Mailing Address - Country:US
Mailing Address - Phone:800-866-0860
Mailing Address - Fax:
Practice Address - Street 1:901 S MO PAC EXPY
Practice Address - Street 2:BLDG II SUITE 450
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5776
Practice Address - Country:US
Practice Address - Phone:512-498-2705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1003612Medicaid
TX1003620Medicaid
TX1003611Medicaid
TX1003615Medicaid
TX1003174Medicaid
TX1003613Medicaid
TX1003619Medicaid
TX10036096114Medicaid
TX1003617Medicaid
TX1003618Medicaid
TX1003175Medicaid
TX1003610Medicaid
TX1003176Medicaid
TX1003178Medicaid
TX1003609Medicaid
TX1003173Medicaid
TX1003177Medicaid
TX1003616Medicaid
TX10036176103Medicaid
TX1003610Medicaid