Healthcare Provider Details

I. General information

NPI: 1396986535
Provider Name (Legal Business Name): SUNDANCE REHABILITATION AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W MAIN ST
HOPKINTON MA
01748-1672
US

IV. Provider business mailing address

101 SUN AVE NE COMPLIANCE DEPARTMENT
ALBUQUERQUE NM
87109-4373
US

V. Phone/Fax

Practice location:
  • Phone: 508-435-1250
  • Fax: 508-435-2213
Mailing address:
  • Phone: 505-468-5604
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateMA

VIII. Authorized Official

Name: SUE GWYN
Title or Position: PRESIDENT DIRECOTR
Credential:
Phone: 617-646-5593