| Maryhaven Center Of Hope Inc | |
|
51 Terryville Rd Port Jefferson Station NY 11776-1331 | |
| (631) 474-4120 | |
| (631) 474-1312 |
| Full Name | Maryhaven Center Of Hope Inc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 51 Terryville Rd, Port Jefferson Station, New York |
| Authorized Official Name and Position | Lewis Grossman (PRESIDENT/CEO) |
| Authorized Official Contact | 6314744120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maryhaven Center Of Hope Inc 51 Terryville Rd Port Jefferson Station NY 11776-1331 Ph: (631) 474-4120 | Maryhaven Center Of Hope Inc 51 Terryville Rd Port Jefferson Station NY 11776-1331 Ph: (631) 474-4120 |
| NPI Number | 1578008124 |
|---|---|
| Provider Enumeration Date | 01/05/2017 |
| Last Update Date | 01/05/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578008124 | NPI | - | NPPES |
| 9RD | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (New York) | Primary |
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