1396953378 NPI number — ALTERNATIVE COMMUNITY LIVING INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396953378 NPI number — ALTERNATIVE COMMUNITY LIVING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTERNATIVE COMMUNITY LIVING INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEW PASSGES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396953378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 LAFAYETTE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48342-2033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-338-7458
Provider Business Mailing Address Fax Number:
248-338-7513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
279 N GROESBECK HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CLEMENS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48043-1546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-627-0024
Provider Business Practice Location Address Fax Number:
586-627-0027
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBS
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-338-7458

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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