Healthcare Provider Details

I. General information

NPI: 1396953378
Provider Name (Legal Business Name): ALTERNATIVE COMMUNITY LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 N GROESBECK HWY
MOUNT CLEMENS MI
48043-1546
US

IV. Provider business mailing address

70 LAFAYETTE ST
PONTIAC MI
48342-2033
US

V. Phone/Fax

Practice location:
  • Phone: 586-627-0024
  • Fax: 586-627-0027
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: DR. DENNIS R JACOBS
Title or Position: CEO
Credential: PHD
Phone: 248-338-7458