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General NPI Number Information
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NPI Number | 1316282130
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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 | 12/05/2012
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 2311 S ILLINOIS AVE
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City | CARBONDALE
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State | IL
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Zip | 62903-5912
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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