MEDICARE: PEARL REHABILITATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1942548011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL REHABILITATION LLC

Provider Business Mailing Address
First Line	:	1273 REMOUNT RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3439
Country	:	US
Telephone Number	:	843-747-2787
Fax Number	:	843-747-0001

Provider Business Practice Location Address
First Line	:	1273 REMOUNT ROAD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3934
Country	:	US
Telephone Number	:	843-747-2787
Fax Number	:	843-747-0001

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RONALD K WHITE
Credential	:
Telephone Number	:	843-200-1878

Provider Enumeration Date	:	01/24/2013
Last Update Date	:	01/24/2013

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