NPIMap

Organization Active NPI

Educare Community Living Corp - North Carolina

  • Intellectual Disabilities Intermediate Care Facility
  • Raleigh, NC
National Provider Identifier
1174643712
Registry record updated Oct 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
EDUCARE COMMUNITY LIVING CORP - NORTH CAROLINA
Practice address
5117 Forest Creek Rd
Raleigh, NC 27606-9419
Phone
(919) 467-2857
NPI assigned
Mar 29, 2007
Last updated
Oct 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Patricia Rodenberg-Roberts
Title
Chief Regulatory Officer Sr Asst GC
Phone
(952) 836-2234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NU Primary

Addresses

Primary practice location

5117 Forest Creek Rd
Raleigh, NC 27606-9419

Mailing address

6600 France Ave S Ste 350
Edina, MN 55435-1810
Phone (800) 388-5150

Other identifiers 1

IdentifierTypeStateIssuer
3406477MedicaidNC

Other names 1

  • EC Ral Forest Creek Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174643712. Details of each certification follow.

  • CCN 34G114 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G114

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
FOREST CREEK GROUP HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 7, 1989
Last certification
Mar 11, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
5117 Forest Creek Drive
Raleigh, NC 27606

National Provider Directory

National Provider Directory
Tax ID family
Community Alternatives North Carolina39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Locations

5117 Forest Creek Rd
Raleigh, NC 27606
Phone (919) 467-2857

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790899200000",
    "number": "1174643712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S STE 350",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351810",
            "telephone_number": "800-388-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5117 FOREST CREEK RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276069419",
            "telephone_number": "919-467-2857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDUCARE COMMUNITY LIVING CORP - NORTH CAROLINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2026-10-02",
        "certification_date": "2026-10-02",
        "status": "A",
        "authorized_official_last_name": "RODENBERG-ROBERTS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "CHIEF REGULATORY OFFICER SR ASST GC",
        "authorized_official_telephone_number": "952-836-2234"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406477",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EC Ral Forest Creek",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.