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General NPI Number Information
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NPI Number | 1093760928
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Entity Type | Organization
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Legal Business Name | SUNDANCE REHABILITATION AGENCY, INC.
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 09/30/2009
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Provider Practice Location Address
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Address Line | 6336 CEDAR LN
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City | COLUMBIA
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State | MD
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Zip | 21044-3897
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Country | US
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Telephone | 410-531-3402
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Fax | 410-531-3402
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Provider Business Mailing Address
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Address Line | 101 SUN AVE NE COMPLIANCE DEPARTMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4373
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Country | US
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Telephone | 505-468-5604
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Fax | 505-468-4681
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Authorized Official
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Title or Position | PRESIDENT DIRECTOR
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Name | SUE GWYN
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Credential |
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Telephone | 617-646-5593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | N/A
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License Number State |
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