Provider Demographics
NPI:1942414305
Name:REHABILITATION CENTERS OF CHARLESTON
Entity Type:Organization
Organization Name:REHABILITATION CENTERS OF CHARLESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-884-7880
Mailing Address - Street 1:586 LONE TREE DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8170
Mailing Address - Country:US
Mailing Address - Phone:843-884-7880
Mailing Address - Fax:843-884-6635
Practice Address - Street 1:3690 BETSY KERRISON PKWY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-7127
Practice Address - Country:US
Practice Address - Phone:843-768-2093
Practice Address - Fax:843-768-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1753Medicaid
SCGP1753Medicaid
SC1248980006Medicare NSC