MEDICARE: MERCY HAVEN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	01304012	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285762716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HAVEN INC

Provider Business Mailing Address
First Line	:	859 CONNETQUOT AVE STE 10
Second Line	:
City	:	ISLIP TERRACE
State	:	NY
Zip	:	11752-1400
Country	:	US
Telephone Number	:	631-277-8300
Fax Number	:	631-277-8394

Provider Business Practice Location Address
First Line	:	859 CONNETQUOT AVE STE 10
Second Line	:
City	:	ISLIP TERRACE
State	:	NY
Zip	:	11752-1400
Country	:	US
Telephone Number	:	631-277-8300
Fax Number	:	631-277-8394

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PATRICIA GRIFFITH
Credential	:	D.MIN.,LMSW
Telephone Number	:	631-277-8300

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/22/2020

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Directions to “MERCY HAVEN INC ” Practice Location

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