MARYHAVEN CENTER OF HOPE INC. NPI 1487799094

NPI Information

NPI: 1487799094
Provider Name: MARYHAVEN CENTER OF HOPE INC.
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address: 450 MYRTLE AVENUE
HOUSE C
PORT JEFFERSON, NY
ZIP 11777
Phone: (631) 474-3400

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NPI Details

MARYHAVEN CENTER OF HOPE INC. is an intermediate care facility mentally retarded in Port Jefferson, NY. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. MARYHAVEN CENTER OF HOPE INC. NPI is 1487799094. The provider is registered as an organization entity type.

The provider's business location address is:

450 MYRTLE AVENUE
HOUSE C
PORT JEFFERSON, NY
ZIP 11777
Phone: (631) 474-3400
Fax: (631) 474-4181

The provider's authorized official is Laura Pepper .
The authorized official title is Director Of Finance and has the following contact phone number (531) 474-4120.

The enumeration date for this NPI number is 2/21/2007 and was last updated on 4/30/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		6639495	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	01042048	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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