Healthcare Provider Details

I. General information

NPI: 1194687285
Provider Name (Legal Business Name): HEALTHCARE OF THE CAROLINAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 VISTA RD
FORT MILL SC
29708-7800
US

IV. Provider business mailing address

1750 HIGHWAY 160 W STE 101-259
FORT MILL SC
29708-8009
US

V. Phone/Fax

Practice location:
  • Phone: 839-400-2400
  • Fax:
Mailing address:
  • Phone: 803-681-0158
  • Fax: 928-218-6384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: COREY WILSON
Title or Position: PHYSICIAN/HOSPITALIST
Credential: MD
Phone: 803-681-0158