Basic Information
| Provider Information | |||||||||
| NPI: | 1982269601 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTERSTONE OF ILLINOIS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628962210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189376483 | ||||||||
| FaxNumber: | 6189371440 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 S BENTLEY ST | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556083560 | ||||||||
| FaxNumber: | 6189970489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2019 | ||||||||
| LastUpdateDate: | 05/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS | ||||||||
| AuthorizedOfficialFirstName: | STACY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE DEPARTMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6189376483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 261QM2800X | N | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.