Provider Demographics
NPI:1538045562
Name:LANTANA WELLNESS CENTER OUTPATIENT LLC
Entity type:Organization
Organization Name:LANTANA WELLNESS CENTER OUTPATIENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-838-9222
Mailing Address - Street 1:4009 MASONBORO LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3640
Mailing Address - Country:US
Mailing Address - Phone:704-838-9222
Mailing Address - Fax:
Practice Address - Street 1:14000 S MILITARY TRL STE 112
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-2600
Practice Address - Country:US
Practice Address - Phone:855-544-0784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility