Organization
TIDELANDS REHABILITATION GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINA MARIA NORENA (COO)
(843) 870-8822
Entity
Organization
Contact information
Practice address
4000 FABER PLACE DR, SUITE 300, NORTH CHARLESTON, SC 29405-8585
(843) 870-8822
(843) 388-0349
Mailing address
4000 FABER PLACE DR, SUITE 300, NORTH CHARLESTON, SC 29405-8585
(843) 870-8822
(843) 388-0349
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
0000
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP5849
—
SC
Enumeration date
02/05/2016
Last updated
02/05/2016
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