Healthcare Provider Details

I. General information

NPI: 1366503443
Provider Name (Legal Business Name): CHARLESTON ORPHAN HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 LACKAWANNA BLVD
NORTH CHARLESTON SC
29405-4529
US

IV. Provider business mailing address

5055 LACKAWANNA BLVD
NORTH CHARLESTON SC
29405-4529
US

V. Phone/Fax

Practice location:
  • Phone: 843-266-5200
  • Fax: 843-266-5201
Mailing address:
  • Phone: 843-266-5200
  • Fax: 843-266-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberSR-0008037001-CCI
License Number StateSC

VIII. Authorized Official

Name: MS. BARBARA KELLEY DUNCAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 843-266-5222