Healthcare Provider Details

I. General information

NPI: 1700747680
Provider Name (Legal Business Name): CENTERSTONE OF ILLINOIS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 YORK ST
QUINCY IL
62301-3963
US

IV. Provider business mailing address

902 W MAIN ST
WEST FRANKFORT IL
62896-2210
US

V. Phone/Fax

Practice location:
  • Phone: 855-608-3560
  • Fax:
Mailing address:
  • Phone: 618-326-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACY D PHILLIPS
Title or Position: VP OF AR
Credential:
Phone: 618-599-6157