# AWAY FROM HOME SENIOR DAY CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720326077
- **Authorized official:** MRS. ELISA MIRIAM BELLIDO (CEO)
- **Authorized official phone:** (917) 796-5622

## Contact information

- **Practice address:** 1500 ROUTE 112, BUILDING 6, SUITE A, PORT JEFFERSON STATION, NY 11776-8054
- **Practice address phone:** (917) 796-5622
- **Mailing address:** 31 JANET ST, PORT JEFFERSON STATION, NY 11776-3613
- **Mailing address phone:** (917) 796-5622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | — | NULL | Yes |
| 311Z00000X | Custodial Care Facility | — | NULL | — |

## Other

- **Enumeration date:** 01/22/2013
- **Last updated:** 01/22/2013