Provider Demographics
NPI:1245772284
Name:HEALTHCARE ALTERNATIVE SYSTEMS
Entity Type:Organization
Organization Name:HEALTHCARE ALTERNATIVE SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-252-3100
Mailing Address - Street 1:4734 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-3322
Mailing Address - Country:US
Mailing Address - Phone:773-252-3100
Mailing Address - Fax:773-252-8945
Practice Address - Street 1:2100 W WARREN BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2310
Practice Address - Country:US
Practice Address - Phone:773-252-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0589-0015-A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-0589-0015-AOtherDHS LICENSURE