Healthcare Provider Details

I. General information

NPI: 1801252531
Provider Name (Legal Business Name): CENTERSTONE OF ILLINOIS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 STATE ST
ALTON IL
62002-4379
US

IV. Provider business mailing address

2302 STATE ST
ALTON IL
62002-4379
US

V. Phone/Fax

Practice location:
  • Phone: 618-937-6483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: STACY PHILLIPS
Title or Position: ACCOUNTS RECEIVEABLE DEPT MANAGER
Credential:
Phone: 618-937-6483