Healthcare Provider Details

I. General information

NPI: 1053756460
Provider Name (Legal Business Name): SUNDANCE REHABILITATION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 SW WINDJAMMER DR
LEES SUMMIT MO
64082-4055
US

IV. Provider business mailing address

817 SW WINDJAMMER DR
LEES SUMMIT MO
64082-4055
US

V. Phone/Fax

Practice location:
  • Phone: 816-506-7766
  • Fax:
Mailing address:
  • Phone: 816-506-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1999135156
License Number StateMO

VIII. Authorized Official

Name: MS. DIANNA R. LARMAN
Title or Position: LPTA
Credential:
Phone: 816-506-7766