Provider Demographics
NPI:1790471852
Name:PHOENIX REHABILITATION AND HEALTH SERVICES OF SOUTH CAROLINA, LLC
Entity Type:Organization
Organization Name:PHOENIX REHABILITATION AND HEALTH SERVICES OF SOUTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDFERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-567-2400
Mailing Address - Street 1:2000 WESTINGHOUSE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5238
Mailing Address - Country:US
Mailing Address - Phone:724-448-2733
Mailing Address - Fax:
Practice Address - Street 1:2900 DREHER SHOALS RD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-7915
Practice Address - Country:US
Practice Address - Phone:803-234-4138
Practice Address - Fax:803-792-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty