Provider Demographics
NPI:1518206440
Name:ALCOHOL SERVICES CENTER, INC.
Entity Type:Organization
Organization Name:ALCOHOL SERVICES CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEBA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHT, LCAC
Authorized Official - Phone:601-948-6220
Mailing Address - Street 1:950 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2566
Mailing Address - Country:US
Mailing Address - Phone:601-948-6220
Mailing Address - Fax:601-948-6244
Practice Address - Street 1:950 N WEST ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2566
Practice Address - Country:US
Practice Address - Phone:601-948-6220
Practice Address - Fax:601-948-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSFS17BADA-OP/P01324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility