Illinois Supreme Health Organization

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ILLINOIS SUPREME HEALTH ORGANIZATION

Practice address

5305 Pleasant LN
Crestwood, IL 60418-1159

Phone

(312) 841-5006

NPI assigned

Mar 13, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Manjhoni EdmondsonNPI 1720581143

Title

President

Phone

(312) 841-5006

Specialties & licenses 1

Addresses

Other names 1

• ISHO Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Manjhoni Edmondson

  • Mental Health Counselor
  • Crestwood, IL
  • NPI 1720581143
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520899200000",
    "number": "1194228429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5305 PLEASANT LN",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604181159",
            "telephone_number": "312-841-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5305 PLEASANT LN",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604181159",
            "telephone_number": "312-841-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS SUPREME HEALTH ORGANIZATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-13",
        "last_updated": "2018-03-13",
        "status": "A",
        "authorized_official_last_name": "EDMONDSON",
        "authorized_official_first_name": "MANJHONI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-841-5006"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ISHO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hope of Life Service Inc
• Anne Marie Horne, FNP-BC
• Leon Hsueh, MD
• Evan Ryan Huffstedtler, DMD
• Jenna Marie Hurckes
• J Revello Chiropractic SC
• Sumaieh Jaber, COTA/L
• JBMV Health Associates, LLC
• Arthur Felipe Jimenez, MS, MA, BCBA, LPC
• Cierra D Johnson, PA-C

• Community/Behavioral Health Agency in Crestwood, IL
• Providers in Crestwood, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.