NPIMap

Organization Active NPI

C-Line Community Outreach Services

  • Multi-Specialty Clinic/Center
  • Jersey City, NJ
National Provider Identifier
1336431675
Registry record updated May 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
2000071 Issued in NJ
Legal business name
C-LINE COMMUNITY OUTREACH SERVICES
Practice address
110 Martin Luther King Jr Dr
Jersey City, NJ 07305-3168
Phone
(201) 200-1965
Fax
(201) 200-1826
NPI assigned
May 4, 2011
Last updated
May 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2014

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

Authorized official

Name
Ms. Caroline Nelson
Title
Executive Director
Phone
(201) 200-1965

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 2000071 NJ Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 37LC00116800 NJ
Mental Health Counselor 101YM0800X 44SC05375200 NJ

Addresses

Primary practice location

110 Martin Luther King Jr Dr
Jersey City, NJ 07305-3168

Mailing address

PO Box 15802
Jersey City, NJ 07305-0802
Phone (201) 200-1965

Other identifiers 1

IdentifierTypeStateIssuer
0352233MedicaidNJ

National Provider Directory

National Provider Directory

Locations

110 Martin Luther King Jr Dr
Ste 1
Jersey City, NJ 07305

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400630400000",
    "number": "1336431675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15802",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073050802",
            "telephone_number": "201-200-1965",
            "fax_number": "201-200-1826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MARTIN LUTHER KING JR DR",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073053168",
            "telephone_number": "201-200-1965",
            "fax_number": "201-200-1826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C-LINE COMMUNITY OUTREACH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2014-05-21",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "201-200-1965",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NJ",
            "license": "2000071",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00116800",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "44SC05375200",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0352233",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2014; 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.