EDUCARE COMMUNITY LIVING CORP NORTH CAROLINA NPI 1639313943

NPI Information

EDUCARE COMMUNITY LIVING CORP NORTH CAROLINA is an intermediate care facility mentally retarded in Winston Salem, NC. The provider is (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. EDUCARE COMMUNITY LIVING CORP NORTH CAROLINA NPI is 1639313943. The provider is registered as an organization entity type.
The provider Is Doing Business As Konnoak Drive Group Home.

The provider's business location address is:

2901 KONNOAK DR
WINSTON SALEM, NC
ZIP 27127-945
Phone: (800) 866-0860

The provider's authorized official is Angie Mattingly .
The authorized official title is Mgr Provider Enrollment and has the following contact phone number (502) 630-7425.

The enumeration date for this NPI number is 4/30/2009 and was last updated on 2/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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