Provider Demographics
NPI:1376943555
Name:RENEWAL REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:RENEWAL REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-813-1476
Mailing Address - Street 1:2885 W 5TH NORTH ST STE A2
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-9628
Mailing Address - Country:US
Mailing Address - Phone:843-970-7010
Mailing Address - Fax:
Practice Address - Street 1:2885 W 5TH NORTH ST STE A2
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-9628
Practice Address - Country:US
Practice Address - Phone:843-970-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy