MEDICARE: C-LINE COMMUNITY OUTREACH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1871146498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C-LINE COMMUNITY OUTREACH SERVICES INC

Provider Business Mailing Address
First Line	:	78 MARTIN LUTHER KING JR DR
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-4690
Country	:	US
Telephone Number	:	201-936-2918
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 MARTIN LUTHER KING JR DR
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-3168
Country	:	US
Telephone Number	:	201-200-1965
Fax Number	:

Authorized Official
Title or Position	:	DO
Name	:	BRITTANY ANDERSON
Credential	:
Telephone Number	:	640-209-2793

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	04/09/2026

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