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	:	1548935877
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	:	890 WILLIAM HILTON PKWY STE 108-C
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-3418
Country	:	US
Telephone Number	:	419-221-6717
Fax Number	:	419-222-0507

Authorized Official
Title or Position	:	EXEC. VP
Name	:	STEPHEN KRZYMINSKI
Credential	:
Telephone Number	:	419-221-6717

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	09/27/2023

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