Provider Demographics
NPI:1235184201
Name:SUNDANCE REHABILITATION AGENCY INC
Entity Type:Organization
Organization Name:SUNDANCE REHABILITATION AGENCY INC
Other - Org Name:SUNDANCE REHABILIATION AGENCY OF CONNECTICUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HIRSCHFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-444-6350
Mailing Address - Street 1:200 NORTHPOINTE CIR
Mailing Address - Street 2:SUITE 302
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 1:628 CONGDON STREET WEST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1967
Practice Address - Country:US
Practice Address - Phone:860-347-7144
Practice Address - Fax:860-347-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A261QR0400X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
076585Medicare Oscar/Certification