National Provider Identifier Database

MARYHAVEN CENTER OF HOPE INC
Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.


Contact Information

MARYHAVEN CENTER OF HOPE INC.
450 MYRTLE AVENUE
HOUSE A
PORT JEFFERSON, NY11777
Phone: 631-474-3400
Fax: 631-474-4181
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X

* Indicates primary specialty

NPI Profile & details for MARYHAVEN CENTER OF HOPE INC.

NPI Number 1568507911
Legal business name
LBN
MARYHAVEN CENTER OF HOPE INC.
Authorized official LAURA PEPPER - (DIRECTOR OF FINANCE)
Entity Organization
Organization subpart No
Enumeration date 02/21/2007
Last updated 04/30/2015 - About 11 years ago
Sole proprietor1 Not specified
Identifiers
  • NY License #: 6639493
  • NY Medicaid: 01036240

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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