1437538014 NPI number — HEALTHCARE ALTERNATIVE SYSTEMS, INC.

Table of content: (NPI 1437538014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437538014 NPI number — HEALTHCARE ALTERNATIVE SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE ALTERNATIVE SYSTEMS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437538014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1713 S ASHLAND AVE
Provider Second Line Business Practice Location Address:
ROOM NO. 702-805
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-505-3173
Provider Business Practice Location Address Fax Number:
312-746-7478
Provider Enumeration Date:
05/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JACOME
Authorized Official First Name:
MARCO
Authorized Official Middle Name:
EDUARDO
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
773-252-3100

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A-0589-0014-A . This is a "SUPR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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