Provider Demographics
NPI:1598253429
Name:EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST
Entity Type:Organization
Organization Name:EDUCARE COMMUNITY LIVING CORPORATION - GULF COAST
Other - Org Name:SADDLE RIDGE
Other - Org Type:Other Name
Authorized Official - Title/Position:PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-394-2100
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:502-394-2100
Mailing Address - Fax:325-949-0646
Practice Address - Street 1:5322 SADDLE RIDGE TRL
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7224
Practice Address - Country:US
Practice Address - Phone:325-942-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities