Provider Demographics
NPI:1881839942
Name:NEW HOPE FOUNDATION FREEHOLD OUTPATIENT
Entity Type:Organization
Organization Name:NEW HOPE FOUNDATION FREEHOLD OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:COMERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-946-3030
Mailing Address - Street 1:2 MONMOUTH AVE # A2
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1970
Mailing Address - Country:US
Mailing Address - Phone:732-308-0113
Mailing Address - Fax:732-308-0115
Practice Address - Street 1:2 MONMOUTH AVE # A2
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1970
Practice Address - Country:US
Practice Address - Phone:732-308-0113
Practice Address - Fax:732-308-0115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW HOPE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ81351324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6190502Medicaid
NJ7632002Medicaid