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General NPI Number Information
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NPI Number | 1235934910
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Entity Type | Organization
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Legal Business Name | LANTERN RESIDENCES
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 3043 MATIPAN AVE
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City | N CHARLESTON
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State | SC
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Zip | 29405-8206
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Country | US
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Telephone | 843-806-1085
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Fax |
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Provider Business Mailing Address
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Address Line | 180 SPRING ST
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City | CHARLESTON
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State | SC
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Zip | 29403-5219
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Country | US
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Telephone | 843-670-3358
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Fax |
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Authorized Official
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Title or Position | OWNER/CLIENT LIASON
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Name | ZACHARY MITCHELL
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Credential | CPSS
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Telephone | 843-834-0448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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