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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/CenterN/A

General Provider Information

NPI Number : 1871548842
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 : 2480 N PARK RD
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021-3744
Country : US
Telephone Number : 954-961-9522
Fax Number : 954-961-9524
Authorized Official
Title or Position : PRESIDENT DIRECTOR
Name : SUE GWYN
Credential :
Telephone Number : 703-684-1004
Provider Enumeration Date : 05/24/2006
Last Update Date : 12/06/2010

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