1649638040 NPI number — TREATMENT ALTERNATIVES FOR SAFE COMMUNITIES

Table of content: (NPI 1649638040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649638040 NPI number — TREATMENT ALTERNATIVES FOR SAFE COMMUNITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TREATMENT ALTERNATIVES FOR SAFE COMMUNITIES
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:
6
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:
1649638040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 S CLINTON ST
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:
60607-4350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-787-0208
Provider Business Mailing Address Fax Number:
312-787-9663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 N OTTAWA ST
Provider Second Line Business Practice Location Address:
540
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60432-4345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-727-0719
Provider Business Practice Location Address Fax Number:
815-727-0725
Provider Enumeration Date:
02/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FESMIRE
Authorized Official First Name:
ROY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT AND CFO
Authorized Official Telephone Number:
312-787-0208

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  A-0637-0045-A , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: A-0637-0045-A , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A-0637-0045-A , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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