Healthcare Provider Details

I. General information

NPI: 1801252390
Provider Name (Legal Business Name): PEACE VALLEY HAVEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 FULTON AVE
HEMPSTEAD NY
11550-3915
US

IV. Provider business mailing address

236 FULTON AVE
HEMPSTEAD NY
11550-3915
US

V. Phone/Fax

Practice location:
  • Phone: 516-223-2355
  • Fax: 516-223-8677
Mailing address:
  • Phone: 516-223-2355
  • Fax: 516-223-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAPHNE HAYNES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 516-223-2355