NPIMap

Organization Active NPI

Maryhaven Center of Hope,Inc

  • Community/Behavioral Health Agency
  • Port Jefferson Station, NY
National Provider Identifier
1790325983
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MARYHAVEN CENTER OF HOPE,INC
Practice address
51 Terryville Rd
Port Jefferson Station, NY 11776-1331
Phone
(631) 474-4120
NPI assigned
Jan 15, 2020
Last updated
Jan 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Authorized official

Name
Maureen Fresolone
Title
Accounting Manager
Phone
(631) 474-4120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

51 Terryville Rd
Port Jefferson Station, NY 11776-1331

Mailing address

51 Terryville Rd
Port Jefferson Station, NY 11776-1359
Phone (631) 474-4120

Other identifiers 1

IdentifierTypeStateIssuer
9RDMedicaidNY

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

NPI Registry JSON

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

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1790325983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 TERRYVILLE RD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761359",
            "telephone_number": "631-474-4120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 TERRYVILLE RD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761331",
            "telephone_number": "631-474-4120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYHAVEN CENTER OF HOPE,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-15",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "FRESOLONE",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_title_or_position": "ACCOUNTING MANAGER",
        "authorized_official_telephone_number": "631-474-4120"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9RD",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; 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.