=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740497858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAKCLIFF CONVALESCENT HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 PLAZA AVE
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06710-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-753-0060
-----------------------------------------------------
Fax | 203-755-9406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 PLAZA AVE
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06710-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-753-0060
-----------------------------------------------------
Fax | 203-755-9406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. RAYMOND T. CRUESS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-753-0060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 3806
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 1688
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------