Healthcare Provider Details

I. General information

NPI: 1619335098
Provider Name (Legal Business Name): TREATMENT ALTERNATIVES FOR SAFE COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S HAMILTON AVE
CHICAGO IL
60612-4207
US

IV. Provider business mailing address

700 S CLINTON ST
CHICAGO IL
60607-4350
US

V. Phone/Fax

Practice location:
  • Phone: 312-666-7339
  • Fax: 312-738-9260
Mailing address:
  • Phone: 312-787-0208
  • Fax: 312-787-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA-0637-0002-A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA-0637-0002-A
License Number StateIL

VIII. Authorized Official

Name: MR. ROY FESMIRE
Title or Position: VICE PRESIDENT AND CFO
Credential:
Phone: 312-787-0208