Provider Demographics
NPI:1124438742
Name:HABILITATIVE SYSTEMS, INC.
Entity type:Organization
Organization Name:HABILITATIVE SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:DEW
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:773-854-1830
Mailing Address - Street 1:415 S KILPATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-4923
Mailing Address - Country:US
Mailing Address - Phone:773-261-2252
Mailing Address - Fax:
Practice Address - Street 1:6845 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636
Practice Address - Country:US
Practice Address - Phone:773-745-2650
Practice Address - Fax:773-349-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04065Medicaid