Provider Demographics
NPI:1396736930
Name:NOTRE DAME HEALTH CARE CENTER,INC
Entity type:Organization
Organization Name:NOTRE DAME HEALTH CARE CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-852-3011
Mailing Address - Street 1:559 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2350
Mailing Address - Country:US
Mailing Address - Phone:508-852-3011
Mailing Address - Fax:508-852-0397
Practice Address - Street 1:559 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2350
Practice Address - Country:US
Practice Address - Phone:508-852-3101
Practice Address - Fax:508-852-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0948314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0920967Medicaid
MA0920967Medicaid