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
226 EASTPORT MANOR ROAD, MANORVILLE, NY 11949
(631) 325-8532
(631) 325-2261
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
6639496
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01101784
—
NY
Enumeration date
02/19/2007
Last updated
05/01/2015
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