Provider Demographics
NPI:1063473460
Name:EDUCARE COMMUNITY LIVING CORP
Entity Type:Organization
Organization Name:EDUCARE COMMUNITY LIVING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL V.P.
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-702-0056
Mailing Address - Street 1:3811 W CHARLESTON BLVD
Mailing Address - Street 2:210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1846
Mailing Address - Country:US
Mailing Address - Phone:702-880-0961
Mailing Address - Fax:702-880-0965
Practice Address - Street 1:3811 W CHARLESTON BLVD
Practice Address - Street 2:210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1846
Practice Address - Country:US
Practice Address - Phone:702-880-0961
Practice Address - Fax:702-880-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness