Organization
MARYHAVEN CENTER OF HOPE,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEWIS GROSSMAN (PRESIDENT/CEO)
(631) 474-4120
Entity
Organization
Contact information
Practice address
150 BUFFALO AVENUE, FREEPORT, NY 11520
(516) 546-7070
(516) 546-7075
Mailing address
51 TERRYVILLE ROAD, PT. JEFFERSON STATION, NY 11776-1331
(631) 474-4120
(631) 474-1312
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
171212059
NY
Other
Enumeration date
02/22/2017
Last updated
02/22/2017
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