Northeast Life Skills Associates Inc

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

22306 Issued in NJ

Legal business name

NORTHEAST LIFE SKILLS ASSOCIATES INC

Practice address

121 Howe Avenue
Passaic, NJ 07055

Phone

(973) 777-2962

Fax

(973) 777-7623

NPI assigned

Nov 9, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Carolyn F. Illge, M.H.S

Title

Executive Director

Phone

(973) 777-2962

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

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.

• Northeast Life Skills Associates, Inc.

  • Methadone Clinic
  • Passaic, NJ
  • NPI 1093707192
  NPD tax ID

Locations

Practitioners 1

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

• Lauren N. Seifert, LPC, LCADC

  • Professional Counselor
  • Passaic, NJ
  • NPI 1972256139
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891865549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 HOWE AVENUE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "07055",
            "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 AVENUE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "07055",
            "telephone_number": "973-777-2962",
            "fax_number": "973-777-7623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST LIFE SKILLS ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ILLGE",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "973-777-2962",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.H.S"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NJ",
            "license": "22306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0101401",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NJWC
• Esther Noble, FNP-C
• Nocd New Jersey PC
• North Hudson Community Action Corporation
• North Hudson Community Action Corporation
• Northeast Life Skills Associates, Inc.
• Northeastern Foot & Ankle Specialists, PC
• Nova Medical Enterprises Limited Liability Company
• Nova Medical Group LLC
• Ian James Nutkis, BCBA

• Methadone Clinic in Passaic, NJ
• Providers in Passaic, NJ by specialty
• Methadone Clinic in New Jersey

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.