Provider Demographics
NPI:1740518240
Name:NEW HOPE FOUNDATION MATTIE HOUSE
Entity type:Organization
Organization Name:NEW HOPE FOUNDATION MATTIE HOUSE
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 1:86 CONOVER RD
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1003
Mailing Address - Country:US
Mailing Address - Phone:732-817-0616
Mailing Address - Fax:732-817-0617
Practice Address - Street 1:86 CONOVER RD
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1003
Practice Address - Country:US
Practice Address - Phone:732-817-0616
Practice Address - Fax:732-817-0617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW HOPE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
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
NJ0189197Medicaid