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General NPI Number Information
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NPI Number | 1518206440
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Entity Type | Organization
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Legal Business Name | ALCOHOL SERVICES CENTER, INC.
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 950 N WEST ST
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City | JACKSON
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State | MS
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Zip | 39202-2566
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Country | US
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Telephone | 601-948-6220
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Fax | 601-948-6244
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Provider Business Mailing Address
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Address Line | 950 N WEST ST
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City | JACKSON
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State | MS
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Zip | 39202-2566
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Country | US
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Telephone | 601-948-6220
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Fax | 601-948-6244
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SHEBA L BORDEN
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Credential | LCMHT, LCAC
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Telephone | 601-948-6220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | FS17BADA-OP/P01
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License Number State | MS
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