Provider Demographics
NPI:1972590156
Name:ROCK HILL MEDSERVE LLC
Entity Type:Organization
Organization Name:ROCK HILL MEDSERVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-327-8655
Mailing Address - Street 1:420 S HERLONG AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9810
Mailing Address - Country:US
Mailing Address - Phone:803-327-8655
Mailing Address - Fax:803-327-8664
Practice Address - Street 1:420 S HERLONG AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9810
Practice Address - Country:US
Practice Address - Phone:803-327-8655
Practice Address - Fax:803-327-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4011Medicaid
SC424511Medicare PIN