| Illinois Supreme Health Organization | |
|
5305 Pleasant Ln Crestwood IL 60418-1159 | |
| (312) 841-5006 | |
| Not Available |
| Full Name | Illinois Supreme Health Organization |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5305 Pleasant Ln, Crestwood, Illinois |
| Authorized Official Name and Position | Manjhoni Edmondson (PRESIDENT) |
| Authorized Official Contact | 3128415006 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illinois Supreme Health Organization 5305 Pleasant Ln Crestwood IL 60418-1159 Ph: (312) 841-5006 | Illinois Supreme Health Organization 5305 Pleasant Ln Crestwood IL 60418-1159 Ph: (312) 841-5006 |
| NPI Number | 1194228429 |
|---|---|
| Provider Enumeration Date | 03/13/2018 |
| Last Update Date | 03/13/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194228429 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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