Tidelands Rehabilitation Group LLC

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

License

0000 Issued in SC

Legal business name

TIDELANDS REHABILITATION GROUP LLC

Practice address

4000 Faber Place Dr
Suite 300
North Charleston, SC 29405-8585

Phone

(843) 870-8822

Fax

(843) 388-0349

NPI assigned

Feb 5, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Lina Maria Norena

Title

Coo

Phone

(843) 870-8822

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454630400000",
    "number": "1972961910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 FABER PLACE DR",
            "address_2": "SUITE 300",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294058585",
            "telephone_number": "843-870-8822",
            "fax_number": "843-388-0349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 FABER PLACE DR",
            "address_2": "SUITE 300",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294058585",
            "telephone_number": "843-870-8822",
            "fax_number": "843-388-0349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDELANDS REHABILITATION GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-05",
        "last_updated": "2016-02-05",
        "status": "A",
        "authorized_official_last_name": "NORENA",
        "authorized_official_first_name": "LINA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "843-870-8822",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "SC",
            "license": "0000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5849",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Rene Thomasson, PA-C
• Rebecca M Thomasson, R.O.T./L
• Ashley Nicole Thompson
• Candice Thompson
• Tammy Laurell Thompson, RN
• Tidewater Surgical Group, PA
• Chris Leo Tierney, DC
• Lynsey Bryce Tiller
• Deeana Lane Tilman, FNP-BC
• Terri Timmerman

• Comprehensive Outpatient Rehabilitation Facility (CORF) in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.