Basic Information
| Provider Information | |||||||||
| NPI: | 1396986535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNDANCE REHABILITATION AGENCY, INC. | ||||||||
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| OtherOrganizationName: | SUNDANCE REHABILIATION AGENCY OF MASSACHUSETTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 SUN AVE NE | ||||||||
| Address2: | COMPLIANCE DEPARTMENT | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054685604 | ||||||||
| FaxNumber: | 5054684681 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HOPKINTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017481672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084351250 | ||||||||
| FaxNumber: | 5084352213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2009 | ||||||||
| LastUpdateDate: | 09/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | GWYN | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT DIRECOTR | ||||||||
| AuthorizedOfficialTelephone: | 6176465593 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUNDANCE REHABILITATION CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.