NPIMap

Organization Active NPI

Maryhaven Center of Hope Inc.

  • Adult Mental Health Clinic/Center
  • Riverhead, NY
National Provider Identifier
1215120399
Registry record updated May 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
6825006A Issued in NY
Legal business name
MARYHAVEN CENTER OF HOPE INC.
Practice address
127 W Main St
Riverhead, NY 11901-2801
Phone
(516) 727-4044
Fax
(516) 727-6531
NPI assigned
Aug 22, 2007
Last updated
May 15, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Pepper
Title
Director of Finance
Phone
(631) 474-4120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 6825006A NY Primary

Addresses

Primary practice location

127 W Main St
Riverhead, NY 11901-2801

Mailing address

51 Terryville Road
Port Jefferson Station, NY 11776
Phone (631) 474-4120

Other identifiers 1

IdentifierTypeStateIssuer
02882424MedicaidNY

National Provider Directory

National Provider Directory

Locations

127 W Main St
Riverhead, NY 11901
Phone (631) 727-4044

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431648000000",
    "number": "1215120399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 TERRYVILLE ROAD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-474-4120",
            "fax_number": "631-474-1312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 W MAIN ST",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012801",
            "telephone_number": "516-727-4044",
            "fax_number": "516-727-6531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYHAVEN CENTER OF HOPE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2015-05-15",
        "status": "A",
        "authorized_official_last_name": "PEPPER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "631-474-4120"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NY",
            "license": "6825006A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02882424",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.