Healthcare Provider Details

I. General information

NPI: 1205886199
Provider Name (Legal Business Name): LANCASTER CHILDRENS HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 CHILDRENS AVE
LANCASTER SC
29720
US

IV. Provider business mailing address

PO BOX 416
LANCASTER SC
29721-0416
US

V. Phone/Fax

Practice location:
  • Phone: 803-286-5277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberSR0008027001CC1
License Number StateSC

VIII. Authorized Official

Name: MS. PATRICIA A CANTY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-286-5277