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NPI Code Detail

MEDICARE: SUNDANCE REHABILITATION AGENCY, INC.

MEDICARE: SUNDANCE REHABILITATION AGENCY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0400XRehabilitation Clinic/CenterMA

General Provider Information

NPI Number : 1396986535
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNDANCE REHABILITATION AGENCY, INC.
Provider Business Mailing Address
First Line : 101 SUN AVE NE
Second Line : COMPLIANCE DEPARTMENT
City : ALBUQUERQUE
State : NM
Zip : 87109-4373
Country : US
Telephone Number : 505-468-5604
Fax Number : 505-468-4681
Provider Business Practice Location Address
First Line : 50 W MAIN ST
Second Line :
City : HOPKINTON
State : MA
Zip : 01748-1672
Country : US
Telephone Number : 508-435-1250
Fax Number : 508-435-2213
Authorized Official
Title or Position : PRESIDENT DIRECOTR
Name : SUE GWYN
Credential :
Telephone Number : 617-646-5593
Provider Enumeration Date : 03/18/2009
Last Update Date : 09/30/2009

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