Healthcare Provider Details

I. General information

NPI: 1073778742
Provider Name (Legal Business Name): NORTH AUGUSTA REHAB HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HUGH STREET SUITE B
NORTH AUGUSTA SC
29841
US

IV. Provider business mailing address

105 HUGH STREET SUITE B
NORTH AUGUSTA SC
29841
US

V. Phone/Fax

Practice location:
  • Phone: 803-426-2000
  • Fax: 803-426-2041
Mailing address:
  • Phone: 803-426-2000
  • Fax: 803-426-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAVELLE R HARDIN
Title or Position: MANAGED CARE ANALYST
Credential:
Phone: 615-344-8203