Provider Demographics
NPI:1588046171
Name:MATHENY SCHOOL AND SCHOOL
Entity Type:Organization
Organization Name:MATHENY SCHOOL AND SCHOOL
Other - Org Name:MATHENY SCHOOL AND HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPROTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:908-234-0011
Mailing Address - Street 1:65 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PEAPACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07977-0339
Mailing Address - Country:US
Mailing Address - Phone:908-234-0011
Mailing Address - Fax:908-234-9367
Practice Address - Street 1:253 GREENDELL ROAD
Practice Address - Street 2:FRELINGHUYSEN COMMUNITY RESIDENCE (STATE)
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860
Practice Address - Country:US
Practice Address - Phone:908-850-5181
Practice Address - Fax:908-850-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ312014Medicare Oscar/Certification
NJ0908540001Medicare NSC