Provider Demographics
NPI:1063629681
Name:ALTERNATIVE COMMUNITY LIVING INC
Entity Type:Organization
Organization Name:ALTERNATIVE COMMUNITY LIVING INC
Other - Org Name:NEW PASSAGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-338-7458
Mailing Address - Street 1:2347 HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-9409
Mailing Address - Country:US
Mailing Address - Phone:810-878-0084
Mailing Address - Fax:810-878-0085
Practice Address - Street 1:70 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2033
Practice Address - Country:US
Practice Address - Phone:248-338-7458
Practice Address - Fax:248-338-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS760260183320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities