Provider Demographics
NPI:1902331317
Name:HOLLOWAY, ISRAEIO (FOUNDER/CEO)
Entity type:Individual
Prefix:MS
First Name:ISRAEIO
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:FOUNDER/CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GIRARD BLVD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433-3105
Mailing Address - Country:US
Mailing Address - Phone:708-537-3369
Mailing Address - Fax:
Practice Address - Street 1:725 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6103
Practice Address - Country:US
Practice Address - Phone:708-537-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-23
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251B00000X, 171M00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health