NPIMap

Organization Active NPI

Maryhaven Center of Hope Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Port Jefferson, NY
National Provider Identifier
1952446569
Registry record updated Apr 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
6639494 Issued in NY
Legal business name
MARYHAVEN CENTER OF HOPE INC.
Practice address
450 Myrtle Avenue
House B
Port Jefferson, NY 11777
Phone
(631) 474-3400
Fax
(631) 474-4181
NPI assigned
Feb 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 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
(531) 474-4120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 6639494 NY Primary

Addresses

Primary practice location

450 Myrtle Avenue
House B
Port Jefferson, NY 11777

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
01036259MedicaidNY

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

450 Myrtle Ave
#B
Port Jefferson, NY 11777
Phone (631) 474-3400

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1952446569",
    "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": "450 MYRTLE AVENUE",
            "address_2": "HOUSE B",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "11777",
            "telephone_number": "631-474-3400",
            "fax_number": "631-474-4181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYHAVEN CENTER OF HOPE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "PEPPER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "531-474-4120"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NY",
            "license": "6639494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01036259",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.