MARYHAVEN CENTER OF HOPE INC. (NPI# 1417149386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417149386 |
| Entity Type | Organization |
| Organization Name | MARYHAVEN CENTER OF HOPE INC. |
| Practice Address |
445 County Road 101 Yaphank NY 11980 |
| Mailing Address |
51 Terryville Road Port Jefferson Station NY 11776 |
| Practice Telephone | 6319245900 |
| Practice Fax Number | 6319242464 |
| Mailing Telephone | 6314744120 |
| Mailing Fax Number | 6314741312 |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2015-05-01 |
| Authorized Official Name | LAURA PEPPER (DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 6314744120 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
6825007A | NY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03012315 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164752101 | Maryhaven Center of Hope Inc. | Community/Behavioral Health | 179 Elmont Road, Elmont, NY 11003 | 2010-01-13 |
| 1306176342 | Maryhaven Center of Hope Inc. | Community/Behavioral Health | 64 N Corona Avenue, Valley Stream, NY 11580 | 2010-01-13 |
| 1003146119 | Maryhaven Center of Hope Inc. | Community/Behavioral Health | 2957 Burns Avenue, Wantagh, NY 11793 | 2010-01-12 |
| 1437294451 | Maryhaven Center of Hope Inc. | Intermediate Care Facility, Mentally Retarded | 9 Miller Place Road, Miller Place, NY 11764 | 2007-02-20 |
| 1225172521 | Maryhaven Center of Hope Inc. | Intermediate Care Facility, Mentally Retarded | 1385 N Ocean Avenue, Medford, NY 11763 | 2007-02-19 |
| 1134263429 | Maryhaven Center of Hope Inc. | Intermediate Care Facility, Mentally Retarded | 452 Miller Place Road, Miller Place, NY 11764 | 2007-02-19 |
| 1013051341 | Maryhaven Center of Hope Inc. | Intermediate Care Facility, Mentally Retarded | 298 Long Island Avenue, Holtsville, NY 11742 | 2007-02-19 |
| 1245374560 | Maryhaven Center of Hope Inc. | Intermediate Care Facility, Mentally Retarded | 226 Eastport Manor Road, Manorville, NY 11949 | 2007-02-19 |
| 1043354681 | Maryhaven Center of Hope Inc. | Intermediate Care Facility, Mentally Retarded | 450 Myrtle Avenue, House 1, Port Jefferson, NY 11777 | 2007-02-16 |
| 1215120399 | Maryhaven Center of Hope Inc. | Clinic/Center | 127 W Main St, Riverhead, NY 11901-2801 | 2007-08-22 |
| Street Address |
445 COUNTY ROAD 101 |
| City | YAPHANK |
| State | NY |
| Zip Code | 11980 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821489113 | Maura Walters | Speech-Language Pathologist | 430 Sills Road, Yaphank, NY 11980 | 2015-02-09 |
| 1033353750 | Samantha Lyn Boutis | Psychologist | 430 Sills Rd, Yaphank, NY 11980 | 2009-04-24 |
| 1326267295 | Wieslawa Zofia Stelzel | Nurse Practitioner | 14 Glover Drive, Jj Foley Snf Suffolk County Department of Health, Yaphank, NY 11980 | 2007-04-25 |
| 1851483879 | Susan Byrne | Social Worker | 1490 Wm Floyd Parkway, Shirley, NY 11980 | 2006-09-28 |
| 1316580111 | Kaylene-lynn Christina Graffitti | Social Worker | 430 Sills Road, Yaphank, NY 11980 | 2019-10-24 |
| 1316506769 | Emily Lynn Martino | Specialist | 430 Sills Rd, Yaphank, NY 11980 | 2019-06-10 |
| 1609433309 | Catherine Gerard | Specialist | 430 Sills Road, Yaphank, NY 11980 | 2019-05-29 |
| 1255801551 | Alexandra Louise Silfer | Physical Therapist | 430 Sills Road, Yaphank, NY 11980 | 2018-11-29 |
| 1487964128 | Florence S Barresi | Occupational Therapist | 430 Sills Rd, Yaphank, NY 11980 | 2010-10-15 |
| 1497064836 | Karen Irene Devries | Physical Therapy Assistant | 430 Sills Rd, Yaphank, NY 11980 | 2010-10-04 |
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| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.