Healthcare Provider Details

I. General information

NPI: 1992598411
Provider Name (Legal Business Name): MATT FAMILY RESIDENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 ARDMOUR DR
MASTIC NY
11950-2017
US

IV. Provider business mailing address

59 ARDMOUR DR
MASTIC NY
11950-2017
US

V. Phone/Fax

Practice location:
  • Phone: 516-643-6233
  • Fax: 631-657-3699
Mailing address:
  • Phone: 516-643-6233
  • Fax: 631-657-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANTZ R MATHIEU
Title or Position: EXECUTIVE DIRECTOR
Credential: NP
Phone: 516-643-6233