Provider Demographics
NPI:1083093330
Name:NEW HOPE FOUNDATION
Entity Type:Organization
Organization Name:NEW HOPE FOUNDATION
Other - Org Name:EPIPHANY HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCHAEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-946-3030
Mailing Address - Street 1:80 CONOVER RD
Mailing Address - Street 2:P.O. BOX 66
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1003
Mailing Address - Country:US
Mailing Address - Phone:732-946-3030
Mailing Address - Fax:732-946-4891
Practice Address - Street 1:1110 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-6012
Practice Address - Country:US
Practice Address - Phone:732-946-3030
Practice Address - Fax:732-946-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000336324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0411779Medicaid