NPIMap

Organization Active NPI

Northeast Life Skills Associates, Inc.

  • Methadone Clinic
  • Passaic, NJ
National Provider Identifier
1093707192
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
22306 Issued in NJ
Legal business name
NORTHEAST LIFE SKILLS ASSOCIATES, INC.
Practice address
121 Howe Ave
Passaic, NJ 07055-4013
Phone
(973) 777-2962
Fax
(973) 777-7623
NPI assigned
Aug 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Carolyn Frances Illge, MHS
Title
Executive Director
Phone
(973) 777-2962

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X 22306 NJ Primary
Methadone Clinic 261QM2800X 10CC00058000 NJ

Addresses

Primary practice location

121 Howe Ave
Passaic, NJ 07055-4013

Mailing address

121 Howe Ave
Passaic, NJ 07055-4013
Phone (973) 777-2962

Other identifiers 2

IdentifierTypeStateIssuer
7633203MedicaidNJ
0101401MedicaidNJ

Other names 1

  • The Passaic Clinic Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Northeast Life Skills Assoc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093707192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 HOWE AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554013",
            "telephone_number": "973-777-2962",
            "fax_number": "973-777-7623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 HOWE AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554013",
            "telephone_number": "973-777-2962",
            "fax_number": "973-777-7623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST LIFE SKILLS ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ILLGE",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "FRANCES",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "973-777-2962",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MHS"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NJ",
            "license": "22306",
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NJ",
            "license": "10CC00058000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7633203",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0101401",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Passaic Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Passaic, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.