MEDICARE: CORA SOUTH CAROLINA 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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1215492129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORA SOUTH CAROLINA LLC

Provider Business Mailing Address
First Line	:	PO BOX 150
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45802-0150
Country	:	US
Telephone Number	:	419-221-6717
Fax Number	:	419-222-0507

Provider Business Practice Location Address
First Line	:	2724 W PALMETTO ST STE 2
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29501-4909
Country	:	US
Telephone Number	:	843-292-1900
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	STEPHEN KRZYMINSKI
Credential	:
Telephone Number	:	419-221-6717

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	10/04/2023

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Directions to “CORA SOUTH CAROLINA LLC ” Practice Location

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