Provider Demographics
NPI:1780042176
Name:TREATMENT ALTERNATIVES FOR SAFE COMMUNITIES
Entity Type:Organization
Organization Name:TREATMENT ALTERNATIVES FOR SAFE COMMUNITIES
Other - Org Name:TASC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:FESMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-787-0208
Mailing Address - Street 1:700 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4350
Mailing Address - Country:US
Mailing Address - Phone:312-787-0208
Mailing Address - Fax:312-787-9663
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2715
Practice Address - Country:US
Practice Address - Phone:217-344-4546
Practice Address - Fax:217-344-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0637-0003-A251S00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-0637-0003-AMedicaid