Organization
ALTERNATIVES FOR LIFE TREATMENT & RECOVERY OF JACKSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUEBEN S BIENVENU (PROGRAM SPONSOR)
(337) 298-1257
Entity
Organization
Contact information
Practice address
5360 I 55 N STE 160, JACKSON, MS 39211-4055
(601) 362-3131
(601) 362-3339
Mailing address
PO BOX 2344, MANDEVILLE, LA 70470-2344
(504) 812-6431
(601) 362-3339
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
MS-10003-M
MS
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
09/23/2008
Last updated
06/17/2021
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