MEDICARE: HABILITATIVE SYSTEMS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	04065	IL
2	251S00000X	Community/Behavioral Health Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1568690261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HABILITATIVE SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	415 S KILPATRICK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-4923
Country	:	US
Telephone Number	:	773-261-2252
Fax Number	:	773-854-8300

Provider Business Practice Location Address
First Line	:	4133 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624
Country	:	US
Telephone Number	:	773-745-2610
Fax Number	:	773-854-8300

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DONALD J. DEW
Credential	:
Telephone Number	:	773-854-1830

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	10/01/2021

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