Basic Information
| Provider Information | |||||||||
| NPI: | 1205096971 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNDANCE REHABILITATION CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 RIGGS RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | SOUTH PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151298917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126533242 | ||||||||
| FaxNumber: | 4126554178 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 RIGGS RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | SOUTH PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151298917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126533242 | ||||||||
| FaxNumber: | 4126554178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2008 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | REDERER | ||||||||
| AuthorizedOfficialFirstName: | SHANNAN | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | THERAPY PROGRAM MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4126533242 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | COTA/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | OP-001698-L | PA | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.