Organization
AWAY FROM HOME ADULT DAY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELISA MIRIAM BELLIDO (PRESIDENT)
(631) 743-9200
Entity
Organization
Contact information
Practice address
1660 ROUTE 112, SUITE G, PORT JEFFERSON STATION, NY 11776-8057
(631) 743-9200
(631) 743-9203
Mailing address
1660 ROUTE 112, SUITE G, PORT JEFFERSON STATION, NY 11776-8057
(631) 743-9200
(631) 743-9203
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
Other
Enumeration date
05/21/2013
Last updated
08/11/2014
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