MEDICARE: CHARLESTON ORPHAN HOUSE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	SR-0008037001-CCI	SC
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366503443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON ORPHAN HOUSE, INC.

Provider Business Mailing Address
First Line	:	5055 LACKAWANNA BLVD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4529
Country	:	US
Telephone Number	:	843-266-5200
Fax Number	:	843-266-5201

Provider Business Practice Location Address
First Line	:	5055 LACKAWANNA BLVD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4529
Country	:	US
Telephone Number	:	843-266-5200
Fax Number	:	843-266-5201

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. BARBARA KELLEY DUNCAN
Credential	:
Telephone Number	:	843-266-5222

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	09/11/2025

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