Provider Demographics
NPI:1285637785
Name:EASTER SEAL SOCIETY OF SOUTH CAROLINA INC
Entity Type:Organization
Organization Name:EASTER SEAL SOCIETY OF SOUTH CAROLINA INC
Other - Org Name:ROSE M. LOWE REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAK
Authorized Official - Suffix:
Authorized Official - Credentials:CHE
Authorized Official - Phone:803-212-8971
Mailing Address - Street 1:101 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8605
Mailing Address - Country:US
Mailing Address - Phone:803-422-3894
Mailing Address - Fax:803-661-8450
Practice Address - Street 1:101 DEER RUN RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8605
Practice Address - Country:US
Practice Address - Phone:803-422-3894
Practice Address - Fax:803-888-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAR0001Medicaid
SCGP7770Medicaid