Healthcare Provider Details

I. General information

NPI: 1538092374
Provider Name (Legal Business Name): WSSH SUNDANCE REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 KINGSWOOD AVE
FOND DU LAC WI
54935-6399
US

IV. Provider business mailing address

9526 W PICO BLVD
LOS ANGELES CA
90035-1202
US

V. Phone/Fax

Practice location:
  • Phone: 323-928-9445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AVROHOM TRESS
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 323-928-9445