Basic Information
| Provider Information | |||||||||
| NPI: | 1801000278 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHABILITATION CENTERS OF CHARLESTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 586 LONE TREE DR | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294648170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438847880 | ||||||||
| FaxNumber: | 8438846635 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 ISLAND PARK DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | DANIEL ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294927559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438847880 | ||||||||
| FaxNumber: | 8438846635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 06/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | BECKHAM | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8438847880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | GP1753 | 05 | SC | MEDICAID |