=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740518240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW HOPE FOUNDATION MATTIE HOUSE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2009
-----------------------------------------------------
Last Update Date | 11/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 86 CONOVER RD
-----------------------------------------------------
City | MARLBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07746-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-817-0616
-----------------------------------------------------
Fax | 732-817-0617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 86 CONOVER RD
-----------------------------------------------------
City | MARLBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07746-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-817-0616
-----------------------------------------------------
Fax | 732-817-0617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. TONY W COMERFORD
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 732-946-3030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 81351
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------