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
9 MILLER PLACE ROAD, MILLER PLACE, NY 11764
(631) 331-5026
(631) 331-1372
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
6639497
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01224473
—
NY
Enumeration date
02/20/2007
Last updated
05/01/2015
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