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Glen Haven Residential Healthcare Fac. Inc

Skilled Nursing Facility in Port Jefferson, NY · enumerated 2005 · authorized official Sanjay Ahuja, Vice President/Secretary.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1396742938

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Registry record

Entity type Organization (Type 2)
Legal business name Glen Haven Residential Healthcare Fac. Inc
Other name <Unavail>
Practice address 150 Dark Hollow Rd, Port Jefferson, NY, 11777
Phone (631) 473-5400
Fax (631) 474-5362
Enumeration date Jun 28, 2005
Last updated in NPPES Jul 9, 2015

Taxonomy & classification

314000000X Skilled Nursing Facility Nursing & Custodial Care Facilities · License 5149303N (NY) Primary

Authorized official

Name Sanjay Ahuja
Title Vice President/Secretary
Phone (631) 473-5400

Other identifiers

Identifier Type State Issuer
01004640 Medicaid NY -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Where is Glen Haven Residential Healthcare Fac. Inc located?
The practice location on file with NPPES is in Port Jefferson, NY.
How current is this record?
Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2015-07-09. Verify at npiregistry.cms.hhs.gov.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2015-07-09.