Glen Haven Residential Healthcare Fac. Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5149303N Issued in NY

Legal business name

GLEN HAVEN RESIDENTIAL HEALTHCARE FAC. INC

Doing business as

Port Jefferson Healthcare Facility Inc

Practice address

150 Dark Hollow Rd
Port Jefferson, NY 11777-2048

Phone

(631) 473-5400

Fax

(631) 474-5362

NPI assigned

Jun 28, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Sanjay Ahuja

Title

Vice President/Secretary

Phone

(631) 473-5400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Port Jefferson Healthcare Facility Inc Doing business as

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436400000000",
    "number": "1396742938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 DARK HOLLOW RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772048",
            "telephone_number": "631-473-5400",
            "fax_number": "631-474-5362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 DARK HOLLOW RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772048",
            "telephone_number": "631-473-5400",
            "fax_number": "631-474-5362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN HAVEN RESIDENTIAL HEALTHCARE FAC. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2015-07-09",
        "status": "A",
        "authorized_official_last_name": "AHUJA",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_title_or_position": "VICE PRESIDENT/SECRETARY",
        "authorized_official_telephone_number": "631-473-5400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "5149303N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01004640",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Jefferson Healthcare Facility Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karen E. Giles, M.AC., L.AC.
• Stephanie Dawn Giraulo, RD
• Kerry Eileen Gitto, OTRL
• Dina Giulietti
• Morton L Glaser, MD
• Caryn J. Gluick, M.A., CCC-SLP
• Darwin Glynn, MD
• Maureen Godfrey
• Yigit Ali Gol, DDS
• Nicole Golbari

• Skilled Nursing Facility in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.