Organization
NORTHEAST LIFE SKILLS ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROLYN F. ILLGE M.H.S (EXECUTIVE DIRECTOR)
(973) 777-2962
Entity
Organization
Contact information
Practice address
121 HOWE AVENUE, PASSAIC, NJ 07055
(973) 777-2962
(973) 777-7623
Mailing address
121 HOWE AVENUE, PASSAIC, NJ 07055
(973) 777-2962
(973) 777-7623
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
22306
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101401
—
NJ
Enumeration date
11/09/2006
Last updated
08/22/2020
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