Provider Demographics
NPI:1720585987
Name:MATHENY SCHOOL AND HOSPITAL
Entity Type:Organization
Organization Name:MATHENY SCHOOL AND HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADETT
Authorized Official - Middle Name:F
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-234-0011
Mailing Address - Street 1:MAIN STREET P.O. BOX 339
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 1:65 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PEAPACK
Practice Address - State:NJ
Practice Address - Zip Code:07977-0339
Practice Address - Country:US
Practice Address - Phone:908-234-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
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
NJ0582603Medicaid