Healthcare Provider Details

I. General information

NPI: 1396736930
Provider Name (Legal Business Name): NOTRE DAME HEALTH CARE CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 PLANTATION ST
WORCESTER MA
01605-2350
US

IV. Provider business mailing address

559 PLANTATION ST
WORCESTER MA
01605-2350
US

V. Phone/Fax

Practice location:
  • Phone: 508-852-3101
  • Fax: 508-852-0397
Mailing address:
  • Phone: 508-852-3011
  • Fax: 508-852-0397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0948
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0920967
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MS. KAREN LAGANELLI
Title or Position: CEO
Credential:
Phone: 508-852-3011