MEDICARE: CHARLESTON ORPHAN HOUSE

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	251S00000X	Community/Behavioral Health Agency	251340133	SC

General Provider Information

NPI Number	:	1437422839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON ORPHAN HOUSE

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	:	BARBARA KELLEY DUNCAN
Credential	:
Telephone Number	:	843-266-5200

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	02/15/2012

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Directions to “CHARLESTON ORPHAN HOUSE ” Practice Location

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