Provider Demographics
NPI:1073662607
Name:SUNDANCE REHABILITATION AGENCY LLC
Entity Type:Organization
Organization Name:SUNDANCE REHABILITATION AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SOIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-925-4088
Mailing Address - Street 1:200 NORTHPOINTE CIR STE 302
Mailing Address - Street 2:
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-7861
Mailing Address - Country:US
Mailing Address - Phone:724-831-5044
Mailing Address - Fax:610-612-5459
Practice Address - Street 1:3001 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2544
Practice Address - Country:US
Practice Address - Phone:918-283-1257
Practice Address - Fax:410-480-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
376631Medicare Oscar/Certification