NPIMap

Organization Active NPI

Maryhaven Center of Hope Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Manorville, NY
National Provider Identifier
1245374560
Registry record updated May 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
6639496 Issued in NY
Legal business name
MARYHAVEN CENTER OF HOPE INC.
Practice address
226 Eastport Manor Road
Manorville, NY 11949
Phone
(631) 325-8532
Fax
(631) 325-2261
NPI assigned
Feb 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 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
Intellectual Disabilities Intermediate Care Facility 315P00000X 6639496 NY Primary

Addresses

Primary practice location

226 Eastport Manor Road
Manorville, NY 11949

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
01101784MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Maryhaven Center of Hope Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

226 Eastport Manor Rd
Manorville, NY 11949
Phone (631) 325-8532

NPI Registry JSON

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430438400000",
    "number": "1245374560",
    "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": "226 EASTPORT MANOR ROAD",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "11949",
            "telephone_number": "631-325-8532",
            "fax_number": "631-325-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYHAVEN CENTER OF HOPE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2015-05-01",
        "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": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NY",
            "license": "6639496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01101784",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manorville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.