| Organization Name: | NORTHEAST LIFE SKILLS ASSOCIATES, INC. |
| NPI Number: | 1093707192 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CAROLYN FRANCES ILLGE (EXECUTIVE DIRECTOR) |
| Mailing Address: | 121 Howe Ave Passaic |
| State: | NJ US |
| Postal Code: | 070554013 |
| Phone Number: | 9737772962 |
| Fax Number: | 9737777623 |
| NPI Enumeration Date: | 08/16/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM2800X |
| License Number: | 10CC00058000 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Methadone Clinic |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |