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
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1972464857
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	:	618-326-2772
Fax Number	:	618-326-2772

Provider Business Practice Location Address
First Line	:	115 N MADISON ST
Second Line	:
City	:	PITTSFIELD
State	:	IL
Zip	:	62363-1405
Country	:	US
Telephone Number	:	855-608-3560
Fax Number	:

Authorized Official
Title or Position	:	VP OF AR
Name	:	STACY D PHILLIPS
Credential	:
Telephone Number	:	618-599-6157

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	11/20/2025

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