Organization
MARYHAVEN CENTER OF HOPE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA PEPPER (DIRECTOR OF FINANCE)
(531) 474-4120
Entity
Organization
Contact information
Practice address
450 MYRTLE AVENUE, HOUSE C, PORT JEFFERSON, NY 11777
(631) 474-3400
(631) 474-4181
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
6639495
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01042048
—
NY
Enumeration date
02/21/2007
Last updated
04/30/2015
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