1073662607 NPI number — SUNDANCE REHABILITATION AGENCY LLC

Table of content: (NPI 1073662607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073662607 NPI number — SUNDANCE REHABILITATION AGENCY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNDANCE REHABILITATION AGENCY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073662607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 NORTHPOINTE CIR STE 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEVEN FIELDS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16046-7861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-831-5044
Provider Business Mailing Address Fax Number:
610-612-5459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 W BLUE STARR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMORE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74017-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-283-1257
Provider Business Practice Location Address Fax Number:
410-480-7169
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOIKA
Authorized Official First Name:
LOUISE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
SVP
Authorized Official Telephone Number:
610-925-4088

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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