Organization
AWAY FROM HOME SENIOR DAY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELISA MIRIAM BELLIDO (CEO)
(917) 796-5622
Entity
Organization
Contact information
Practice address
1500 ROUTE 112, BUILDING 6, SUITE A, PORT JEFFERSON STATION, NY 11776-8054
(917) 796-5622
Mailing address
31 JANET ST, PORT JEFFERSON STATION, NY 11776-3613
(917) 796-5622
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
—
—
311Z00000X
Custodial Care Facility
—
—
Other
Enumeration date
01/22/2013
Last updated
01/22/2013
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