# LANTERN OF CRESCENT CITY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SRSO, LLC
- **Other names:** Lantern Health Crescent City
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1174921050
- **Legal business name:** SRSO, LLC
- **Authorized official:** SPENCER ROBERT SAMUELIAN (MANAGER)
- **Authorized official phone:** (949) 445-1000

## Contact information

- **Practice address:** 4 S STONINGTON RD, LAGUNA BEACH, CA 92651-6741
- **Practice address phone:** (949) 445-1000
- **Mailing address:** 4 S STONINGTON RD, LAGUNA BEACH, CA 92651-6741
- **Mailing address phone:** (949) 445-1000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 12/09/2014
- **Last updated:** 12/09/2014