Provider Demographics
NPI:1063810992
Name:ATHENA HOME HEALTH LLC
Entity type:Organization
Organization Name:ATHENA HOME HEALTH 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 1:135 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2556
Mailing Address - Country:US
Mailing Address - Phone:860-751-3620
Mailing Address - Fax:860-470-7972
Practice Address - Street 1:135 SOUTH RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2556
Practice Address - Country:US
Practice Address - Phone:860-751-3620
Practice Address - Fax:860-470-7972
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEATH CARE ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-09
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008058655Medicaid
NY05485016Medicaid