Healthcare Provider Details

I. General information

NPI: 1457357352
Provider Name (Legal Business Name): HEALTHCARE ALTERNATIVE SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 W ARMITAGE AVE
CHICAGO IL
60647-4244
US

IV. Provider business mailing address

4734 W CHICAGO AVE
CHICAGO IL
60651-3322
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA-0589-0001-A
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCO E JACOME
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-252-3100