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General NPI Number Information
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NPI Number | 1992598411
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Entity Type | Organization
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Legal Business Name | MATT FAMILY RESIDENCY
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 59 ARDMOUR DR
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City | MASTIC
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State | NY
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Zip | 11950-2017
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Country | US
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Telephone | 516-643-6233
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Fax | 631-657-3699
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Provider Business Mailing Address
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Address Line | 59 ARDMOUR DR
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City | MASTIC
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State | NY
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Zip | 11950-2017
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Country | US
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Telephone | 516-643-6233
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Fax | 631-657-3699
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. FRANTZ R MATHIEU
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Credential | NP
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Telephone | 516-643-6233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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