| Maryhaven Center Of Hope,inc | |
|
51 Terryville Rd Port Jefferson Station NY 11776-1331 | |
| (631) 474-4120 | |
| Not Available |
| Full Name | Maryhaven Center Of Hope,inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 51 Terryville Rd, Port Jefferson Station, New York |
| Authorized Official Name and Position | Maureen Fresolone (ACCOUNTING MANAGER) |
| 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 11776-1359 Ph: (631) 474-4120 | Maryhaven Center Of Hope,inc 51 Terryville Rd Port Jefferson Station NY 11776-1331 Ph: (631) 474-4120 |
| NPI Number | 1790325983 |
|---|---|
| Provider Enumeration Date | 01/15/2020 |
| Last Update Date | 01/15/2020 |
| Certification Date | 01/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790325983 | NPI | - | NPPES |
| 9RD | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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