Healthcare Provider Details

I. General information

NPI: 1487860219
Provider Name (Legal Business Name): ALTERNATIVE COMMUNITY LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 ELDON BAKER DR
FLINT MI
48507-1923
US

IV. Provider business mailing address

70 LAFAYETTE ST
PONTIAC MI
48342-2033
US

V. Phone/Fax

Practice location:
  • Phone: 810-235-3288
  • Fax: 810-496-8539
Mailing address:
  • Phone: 248-338-7458
  • Fax: 248-338-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP WEAVER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 616-301-8000