Organization
MARYHAVEN CENTER OF HOPE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA PEPPER (DIRECTOR OF FINANCE)
(631) 474-4120
Entity
Organization
Contact information
Practice address
127 W MAIN ST, RIVERHEAD, NY 11901-2801
(516) 727-4044
(516) 727-6531
Mailing address
51 TERRYVILLE ROAD, PORT JEFFERSON STATION, NY 11776
(631) 474-4120
(631) 474-1312
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
6825006A
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02882424
—
NY
Enumeration date
08/22/2007
Last updated
05/15/2015
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