| NPI | 1093707192 |
|---|---|
| Former Legal Business Name | THE PASSAIC CLINIC |
| Entity Type | Organization |
| Authorized Contact | CAROLYN FRANCES ILLGE Executive Director 973-777-2962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: NJ 22306) |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic (Licence: NJ 10CC00058000) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2020-08-22 |