Healthcare Provider Details

I. General information

NPI: 1376880633
Provider Name (Legal Business Name): GLOBAL REHABILITATION FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 HONEY HILL ST RM # 3
GEORGETOWN SC
29440-5773
US

IV. Provider business mailing address

PO BOX 16002
SURFSIDE BEACH SC
29587-6002
US

V. Phone/Fax

Practice location:
  • Phone: 843-957-9424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES PRIOR
Title or Position: PRESIDENT
Credential:
Phone: 843-957-9424