Healthcare Provider Details

I. General information

NPI: 1326631391
Provider Name (Legal Business Name): CORA SOUTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MOSS CREEK VLG
HILTON HEAD SC
29926-1105
US

IV. Provider business mailing address

PO BOX 150
LIMA OH
45802-0150
US

V. Phone/Fax

Practice location:
  • Phone: 843-836-7003
  • Fax: 419-222-0507
Mailing address:
  • Phone: 419-221-6717
  • Fax: 419-222-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRAD ROUSH
Title or Position: EXEC VP
Credential:
Phone: 419-221-6712