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
51 TERRYVILLE RD, PORT JEFFERSON STATION, NY 11776-1331
(631) 474-4120
(631) 474-1312
Mailing address
51 TERRYVILLE RD, PORT JEFFERSON STATION, NY 11776-1331
(631) 474-4120
(631) 474-1312
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9RD
—
NY
Enumeration date
01/05/2017
Last updated
01/05/2017
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