Provider Demographics
NPI:1649330820
Name:NOTRE DAME CONVALESCENT HOME INC
Entity type:Organization
Organization Name:NOTRE DAME CONVALESCENT HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRPAK
Authorized Official - Suffix:
Authorized Official - Credentials:BOM
Authorized Official - Phone:203-847-5893
Mailing Address - Street 1:76 WEST ROCKS ROAD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-2231
Mailing Address - Country:US
Mailing Address - Phone:203-847-5893
Mailing Address - Fax:203-849-1959
Practice Address - Street 1:76 WEST ROCKS ROAD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-2231
Practice Address - Country:US
Practice Address - Phone:203-847-5893
Practice Address - Fax:203-849-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
075356Medicare ID - Type Unspecified