Provider Demographics
NPI:1790176121
Name:HEALTHCARE ALTERNATIVE SYSTEMS, INC.
Entity Type:Organization
Organization Name:HEALTHCARE ALTERNATIVE SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACOME
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CAADC, CEAP
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 1:1915-17 W. ROOSEVELT RD.
Practice Address - Street 2:
Practice Address - City:BROADVIEW
Practice Address - State:IL
Practice Address - Zip Code:60155
Practice Address - Country:US
Practice Address - Phone:708-334-7089
Practice Address - Fax:708-334-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12001261QM0801X
ILA-0589-O013-A261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-0589-O013-AOtherDASA