Organization
EDUCARE COMMUNITY LIVING LIMITED PARTNERSHIP
Active
Other names
HTX NORTHWEST VILLA
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY TYLER WHOBREY (PROVIDER ENROLLMENT)
(502) 630-7249
Entity
Organization
Contact information
Practice address
15062 COUNTY ROAD 1145, TYLER, TX 75704-7516
(502) 394-2100
(903) 596-8104
Mailing address
805 N WHITTINGTON PKWY, LOUISVILLE, KY 40222-5186
(800) 866-0860
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001000385
—
TX
Enumeration date
03/31/2007
Last updated
05/28/2019
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