Organization
NORTHEAST LIFE SKILLS ASSOCIATES, INC.
Active
Other names
The Passaic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROLYN FRANCES ILLGE MHS (EXECUTIVE DIRECTOR)
(973) 777-2962
Entity
Organization
Contact information
Practice address
121 HOWE AVE, PASSAIC, NJ 07055-4013
(973) 777-2962
(973) 777-7623
Mailing address
121 HOWE AVE, PASSAIC, NJ 07055-4013
(973) 777-2962
(973) 777-7623
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
10CC00058000
NJ
261QM2800X
Methadone Clinic
Primary
22306
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101401
—
NJ
05
—
7633203
—
NJ
Enumeration date
08/16/2005
Last updated
08/22/2020
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