Organization
GLEN HAVEN RESIDENTIAL HEALTHCARE FAC. INC
Active
Other names
Port Jefferson Healthcare Facility Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SANJAY AHUJA (VICE PRESIDENT/SECRETARY)
(631) 473-5400
Entity
Organization
Contact information
Practice address
150 DARK HOLLOW RD, PORT JEFFERSON, NY 11777-2048
(631) 473-5400
(631) 474-5362
Mailing address
150 DARK HOLLOW RD, PORT JEFFERSON, NY 11777-2048
(631) 473-5400
(631) 474-5362
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5149303N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01004640
—
NY
Enumeration date
06/28/2005
Last updated
07/09/2015
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