MEDICARE: HEALTHCARE ALTERNATIVE 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	A-0589-0007-A	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1834	OTHER	IL	BLUE CROSS
2	0589	OTHER	IL	DASA
3	49688000	OTHER	IL	MAGELLAN
4	4478219	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1588792550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCARE ALTERNATIVE SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	4734 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3322
Country	:	US
Telephone Number	:	773-252-3100
Fax Number	:	773-252-8945

Provider Business Practice Location Address
First Line	:	5005 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2413
Country	:	US
Telephone Number	:	773-745-7107
Fax Number	:	773-745-9902

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MARCO E JACOME
Credential	:
Telephone Number	:	773-252-3100

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	02/21/2023

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