Provider Demographics
NPI:1720326077
Name:AWAY FROM HOME SENIOR DAY CARE
Entity Type:Organization
Organization Name:AWAY FROM HOME SENIOR DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:MIRIAM
Authorized Official - Last Name:BELLIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-796-5622
Mailing Address - Street 1:31 JANET ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3613
Mailing Address - Country:US
Mailing Address - Phone:917-796-5622
Mailing Address - Fax:
Practice Address - Street 1:1500 ROUTE 112
Practice Address - Street 2:BUILDING 6, SUITE A
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-8054
Practice Address - Country:US
Practice Address - Phone:917-796-5622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility