Healthcare Provider Details

I. General information

NPI: 1992138325
Provider Name (Legal Business Name): HEALTHCARE ALTERNATIVE SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 W FULLERTON AVE
CHICAGO IL
60639-2413
US

IV. Provider business mailing address

4734 W CHICAGO AVE
CHICAGO IL
60651-3322
US

V. Phone/Fax

Practice location:
  • Phone: 773-745-7107
  • Fax: 773-745-9902
Mailing address:
  • Phone: 773-252-3100
  • Fax: 773-252-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number12001
License Number StateIL

VIII. Authorized Official

Name: MARCO JACOME
Title or Position: CEO
Credential:
Phone: 773-252-3100