# MARYHAVEN CENTER OF HOPE INC.

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

## Provider details

- **NPI number:** 1225172521
- **Authorized official:** LAURA PEPPER (DIRECTOR OF FINANCE)
- **Authorized official phone:** (631) 474-4120

## Contact information

- **Practice address:** 1385 N OCEAN AVENUE, MEDFORD, NY 11763
- **Practice address phone:** (631) 289-6157
- **Practice address fax:** (631) 475-2477
- **Mailing address:** 51 TERRYVILLE ROAD, PORT JEFFERSON STATION, NY 11776
- **Mailing address phone:** (631) 474-4120
- **Mailing address fax:** (631) 474-1312

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | 6639491 | NY | Yes |

## Other

- **Enumeration date:** 02/19/2007
- **Last updated:** 05/01/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01008171 | — | NY |