MEDICARE: HALL REHABILITATIVE CLINIC

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20048858	OTHER	SC	SELECT HEALTH OF SC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770667867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALL REHABILITATIVE CLINIC

Provider Business Mailing Address
First Line	:	1800 COLONIAL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6827
Country	:	US
Telephone Number	:	803-935-6977
Fax Number	:	803-965-7349

Provider Business Practice Location Address
First Line	:	2100 BULL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201
Country	:	US
Telephone Number	:	803-935-6977
Fax Number	:	803-935-7349

Authorized Official
Title or Position	:	DIRECTOR OF WSHPI
Name	:	DR. ANGELA FORAND
Credential	:	PHD
Telephone Number	:	803-898-1593

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	01/25/2011

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Directions to “HALL REHABILITATIVE CLINIC ” Practice Location

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