Provider Demographics
NPI:1023098753
Name:PHC REHAB, INC.
Entity type:Organization
Organization Name:PHC REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DURRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-762-3601
Mailing Address - Street 1:1548 ASHLEY RIVER ROAD SUITE C
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:843-766-3888
Mailing Address - Fax:843-766-3478
Practice Address - Street 1:418 B FOLLY ROAD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-766-3888
Practice Address - Fax:843-766-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1708Medicaid
SCGP1708Medicaid