Organization
LANTANA RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WARREN PHILLIPS (OWNER)
(314) 603-3492
Entity
Organization
Contact information
Practice address
65 GADSDEN ST, CHARLESTON, SC 29401-1145
(314) 603-3492
Mailing address
65 GADSDEN ST, CHARLESTON, SC 29401-1145
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
11/12/2019
Last updated
07/31/2021
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