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-0589-0002-A	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0589	OTHER	IL	DASA
2	1834	OTHER	IL	BLUE CROSS
3	4478219	OTHER	IL	AETNA
4	496988000	OTHER	IL	MAGELLAN

General Provider Information

NPI Number	:	1811025687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCARE ALTERNATIVE SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	2755 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4244
Country	:	US
Telephone Number	:	773-252-3100
Fax Number	:	773-252-8945

Provider Business Practice Location Address
First Line	:	1942 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4247
Country	:	US
Telephone Number	:	773-292-4242
Fax Number	:	773-292-0355

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	:	01/03/2017

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