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General NPI Number Information
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NPI Number | 1033570262
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Entity Type | Organization
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Legal Business Name | CENTERSTONE OF ILLINOIS, INC
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 2615 EDWARDS ST
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City | ALTON
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State | IL
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Zip | 62002-3915
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Country | US
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Telephone | 618-937-6483
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Fax |
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Provider Business Mailing Address
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Address Line | 902 W MAIN ST
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City | WEST FRANKFORT
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State | IL
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Zip | 62896-2210
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Country | US
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Telephone | 618-937-6483
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Fax | 618-937-1440
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE CYCLES
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Name | STACY PHILLIPS
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Credential |
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Telephone | 618-937-6483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | A-0234-0010-A
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | A-0234-0010-A
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License Number State | IL
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