Healthcare Provider Details

I. General information

NPI: 1033570262
Provider Name (Legal Business Name): CENTERSTONE OF ILLINOIS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 EDWARDS ST
ALTON IL
62002-3915
US

IV. Provider business mailing address

902 W MAIN ST
WEST FRANKFORT IL
62896-2210
US

V. Phone/Fax

Practice location:
  • Phone: 618-937-6483
  • Fax:
Mailing address:
  • Phone: 618-937-6483
  • Fax: 618-937-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberA-0234-0010-A
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA-0234-0010-A
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: STACY PHILLIPS
Title or Position: DIRECTOR OF REVENUE CYCLES
Credential:
Phone: 618-937-6483