Provider Demographics
NPI:1427381672
Name:ARDIS B. HONOHAN
Entity Type:Organization
Organization Name:ARDIS B. HONOHAN
Other - Org Name:SACHEM ASSISTED LIVING PROGRAM; SOUTH BAY ASSISTED LIVING PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ARDIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:HONOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-588-4554
Mailing Address - Street 1:1298 COATES AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2440
Mailing Address - Country:US
Mailing Address - Phone:631-588-4554
Mailing Address - Fax:631-588-4578
Practice Address - Street 1:1298 COATES AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2440
Practice Address - Country:US
Practice Address - Phone:631-588-4554
Practice Address - Fax:631-588-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY700-F-113310400000X
NY700-F-069310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility