Healthcare Provider Details

I. General information

NPI: 1376817916
Provider Name (Legal Business Name): CENTERSTONE OF ILLINOIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 1/2 W CHERRY ST
MARION IL
62959-1920
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: 618-937-1440
Mailing address:
  • Phone: 618-937-6483
  • Fax: 618-937-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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