NPIMap

Organization Active NPI

PHC Rehab, Inc.

  • Rehabilitation Clinic/Center
  • Charleston, SC
National Provider Identifier
1023098753
Registry record updated Mar 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PHC REHAB, INC.
Practice address
418 B Folly Road
Charleston, SC 29412
Phone
(843) 766-3888
Fax
(843) 766-3478
NPI assigned
Jan 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Ellen S Durrence, R.PH
Title
Vice President
Phone
(843) 762-3601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

418 B Folly Road
Charleston, SC 29412

Mailing address

1548 Ashley River Road Suite C
Charleston, SC 29407
Phone (843) 766-3888

Other identifiers 1

IdentifierTypeStateIssuer
GP1708MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111229000630 SC Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 5193991859 Practice locations: Charleston, SC

National Provider Directory

National Provider Directory
Tax ID family
P H C Rehab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

408 Folly Rd
Ste B
Charleston, SC 29412
Phone (843) 766-3888

1548 Ashley River Rd
Ste C
Charleston, SC 29407

418 Folly Rd
Ste B
Charleston, SC 29412
Phone (843) 766-3888

1925B Maybank Hwy
Charleston, SC 29412

418 Folly Rd
#B
Charleston, SC 29412
Phone (843) 766-3888

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646265600000",
    "number": "1023098753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1548 ASHLEY RIVER ROAD SUITE C",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29407",
            "telephone_number": "843-766-3888",
            "fax_number": "843-766-3478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 B FOLLY ROAD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29412",
            "telephone_number": "843-766-3888",
            "fax_number": "843-766-3478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHC REHAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A",
        "authorized_official_last_name": "DURRENCE",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "843-762-3601",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1708",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.