# CORA SOUTH CAROLINA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104380344
- **Authorized official:** MR. BRAD C. ROUSH (EXECUTIVE VICE PRESIDENT)
- **Authorized official phone:** (419) 221-6712

## Contact information

- **Practice address:** 876 FORDING ISLAND RD STE 2, BLUFFTON, SC 29910-8677
- **Practice address phone:** (843) 507-8473
- **Practice address fax:** (843) 868-8043
- **Mailing address:** 1110 SHAWNEE RD, LIMA, OH 45805-3529
- **Mailing address phone:** (419) 221-6720
- **Mailing address fax:** (419) 222-0507

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/22/2019
- **Last updated:** 01/22/2019