Healthcare Provider Details

I. General information

NPI: 1740497858
Provider Name (Legal Business Name): OAKCLIFF CONVALESCENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 PLAZA AVE
WATERBURY CT
06710-1504
US

IV. Provider business mailing address

71 PLAZA AVE
WATERBURY CT
06710-1504
US

V. Phone/Fax

Practice location:
  • Phone: 203-753-0060
  • Fax: 203-755-9406
Mailing address:
  • Phone: 203-753-0060
  • Fax: 203-755-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number1688
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3806
License Number StateCT

VIII. Authorized Official

Name: MR. RAYMOND T. CRUESS
Title or Position: ADMINISTRATOR
Credential:
Phone: 203-753-0060