Provider Demographics
NPI:1568587756
Name:LOURDES HEALTHCARE CENTER, INC.
Entity Type:Organization
Organization Name:LOURDES HEALTHCARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUCCIARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-762-4135
Mailing Address - Street 1:345 BELDEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3800
Mailing Address - Country:US
Mailing Address - Phone:203-762-3318
Mailing Address - Fax:203-762-2144
Practice Address - Street 1:345 BELDEN HILL RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3800
Practice Address - Country:US
Practice Address - Phone:203-762-3318
Practice Address - Fax:203-762-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2243314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075426Medicare ID - Type Unspecified