Healthcare Provider Details

I. General information

NPI: 1962776443
Provider Name (Legal Business Name): SUNDANCE REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 WOODSPOINT DRIVE
FLORENCE KY
41042
US

IV. Provider business mailing address

7300 WOODSPOINT DR
FLORENCE KY
41042-1543
US

V. Phone/Fax

Practice location:
  • Phone: 859-283-1346
  • Fax: 859-980-1444
Mailing address:
  • Phone: 859-283-1346
  • Fax: 859-980-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number1938
License Number StateKY

VIII. Authorized Official

Name: MRS. ANN HONCHELL KING
Title or Position: SPEECH PATHOLOGIST
Credential: MACCC-SLP
Phone: 513-505-2323