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NPI Code Detail

MEDICARE: CENTERSTONE OF ILLINOIS, INC

MEDICARE: CENTERSTONE OF ILLINOIS, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1386969533
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERSTONE OF ILLINOIS, INC
Provider Business Mailing Address
First Line : 902 W MAIN ST
Second Line :
City : WEST FRANKFORT
State : IL
Zip : 62896-2210
Country : US
Telephone Number : 618-937-6483
Fax Number : 618-937-1440
Provider Business Practice Location Address
First Line : 1307 W MAIN ST
Second Line :
City : MARION
State : IL
Zip : 62959-1139
Country : US
Telephone Number : 618-997-5336
Fax Number : 618-993-2969
Authorized Official
Title or Position : DIRECTOR OF REVENUE CYCLES
Name : STACY PHILLIPS
Credential :
Telephone Number : 618-937-6483
Provider Enumeration Date : 03/31/2010
Last Update Date : 07/14/2025

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Directions to “CENTERSTONE OF ILLINOIS, INC ” Practice Location

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