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
1385 N OCEAN AVENUE, MEDFORD, NY 11763
(631) 289-6157
(631) 475-2477
Mailing address
51 TERRYVILLE ROAD, PORT JEFFERSON STATION, NY 11776
(631) 474-4120
(631) 474-1312
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
6639491
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01008171
—
NY
Enumeration date
02/19/2007
Last updated
05/01/2015
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