Organization
ILLINOIS SUPREME HEALTH ORGANIZATION
Active
Other names
ISHO
Organization subpart
No
Provider details
NPI number
Authorized official
MANJHONI EDMONDSON (PRESIDENT)
(312) 841-5006
Entity
Organization
Contact information
Practice address
5305 PLEASANT LN, CRESTWOOD, IL 60418-1159
(312) 841-5006
Mailing address
5305 PLEASANT LN, CRESTWOOD, IL 60418-1159
(312) 841-5006
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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