Organization
MARYHAVEN CENTER OF HOPE,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN FRESOLONE (ACCOUNTING MANAGER)
(631) 474-4120
Entity
Organization
Contact information
Practice address
51 TERRYVILLE RD, PORT JEFFERSON STATION, NY 11776-1331
(631) 474-4120
Mailing address
51 TERRYVILLE RD, PORT JEFFERSON STATION, NY 11776-1359
(631) 474-4120
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9RD
—
NY
Enumeration date
01/15/2020
Last updated
01/15/2020
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