Provider Demographics
NPI:1821248279
Name:ALTERNATIVES FOR LIFE TREATMENT & RECOVERY OF JACKSON LLC
Entity Type:Organization
Organization Name:ALTERNATIVES FOR LIFE TREATMENT & RECOVERY OF JACKSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUEBEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BIENVENU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-298-1257
Mailing Address - Street 1:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-2344
Mailing Address - Country:US
Mailing Address - Phone:504-812-6431
Mailing Address - Fax:601-362-3339
Practice Address - Street 1:5360 I 55 N STE 160
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-4055
Practice Address - Country:US
Practice Address - Phone:601-362-3131
Practice Address - Fax:601-362-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS-10003-M261Q00000X
261QM2800X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder