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Organization
EDUCARE COMMUNITY LIVING CORP NORTH CAROLINA
Active
Organization
EDUCARE COMMUNITY LIVING CORP NORTH CAROLINA
Active
Other names
Konnoak Drive Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE MATTINGLY (MGR PROVIDER ENROLLMENT)
(502) 630-7425
Entity
Organization
Contact information
Practice address
2901 KONNOAK DR, WINSTON SALEM, NC 27127-3945
(800) 866-0860
Mailing address
805 N WHITTINGTON PKWY, LOUISVILLE, KY 40222-7101
(800) 866-0860
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NC
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
342606W
—
NC
Enumeration date
04/30/2009
Last updated
02/21/2022
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