Basic Information
| Provider Information | |||||||||
| NPI: | 1811354020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNDANCE REHABILITATION AGENCY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E STATE ST | ||||||||
| Address2: | C/O AMY NUNEMAKER | ||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193483109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109254560 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 CHERRY ST | ||||||||
| Address2: | C/O SOLDIER'S HOME | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010407002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135384184 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 02/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | SOIKA | ||||||||
| AuthorizedOfficialFirstName: | LOUISE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP | ||||||||
| AuthorizedOfficialTelephone: | 6109254088 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.