Provider Demographics
NPI:1649216748
Name:ATHENA HOLDINGS LLC
Entity type:Organization
Organization Name:ATHENA HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:642 DANBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877
Mailing Address - Country:US
Mailing Address - Phone:203-438-8226
Mailing Address - Fax:203-438-8378
Practice Address - Street 1:642 DANBURY ROAD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877
Practice Address - Country:US
Practice Address - Phone:203-438-8226
Practice Address - Fax:203-438-8378
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-20
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2247314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
000021262OtherSNF
CT000095324Medicaid
075395Medicare ID - Type Unspecified