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General NPI Number Information
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NPI Number | 1811754773
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Entity Type | Organization
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Legal Business Name | LANTANA RECOVERY OF CONNECTICUT, LLC
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 143 WEST ST
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City | NEW MILFORD
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State | CT
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Zip | 06776-3599
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Country | US
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Telephone | 203-598-2738
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Fax |
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Provider Business Mailing Address
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Address Line | 65 GADSDEN ST
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City | CHARLESTON
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State | SC
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Zip | 29401-1145
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | MR. ALAN GOODSTAT
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Credential | LCSW
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Telephone | 954-415-0758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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