Provider Demographics
NPI:1942992920
Name:SUPERIOR TREATMENT AND RELIABLE SERVICES
Entity Type:Organization
Organization Name:SUPERIOR TREATMENT AND RELIABLE SERVICES
Other - Org Name:S.T.A.R.S. HCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANICA
Authorized Official - Middle Name:EDRIRE JOI
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-517-7398
Mailing Address - Street 1:5107 W WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-5020
Mailing Address - Country:US
Mailing Address - Phone:309-517-7398
Mailing Address - Fax:
Practice Address - Street 1:165 W 10TH ST STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-2000
Practice Address - Country:US
Practice Address - Phone:309-517-7398
Practice Address - Fax:309-524-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care