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General NPI Number Information
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NPI Number | 1285762716
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Entity Type | Organization
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Legal Business Name | MERCY HAVEN INC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 859 CONNETQUOT AVE STE 10
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City | ISLIP TERRACE
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State | NY
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Zip | 11752-1400
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Country | US
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Telephone | 631-277-8300
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Fax | 631-277-8394
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Provider Business Mailing Address
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Address Line | 859 CONNETQUOT AVE STE 10
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City | ISLIP TERRACE
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State | NY
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Zip | 11752-1400
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Country | US
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Telephone | 631-277-8300
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Fax | 631-277-8394
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PATRICIA GRIFFITH
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Credential | D.MIN.,LMSW
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Telephone | 631-277-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 01304012
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License Number State | NY
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