Provider Demographics
NPI:1346447125
Name:SUNDANCE HOME HEALTH CARE,INC.
Entity Type:Organization
Organization Name:SUNDANCE HOME HEALTH CARE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ATIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAITLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-424-7207
Mailing Address - Street 1:15565 NORTHLAND DR
Mailing Address - Street 2:401-E
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-424-7207
Mailing Address - Fax:248-424-7208
Practice Address - Street 1:15565 NORTHLAND DR W
Practice Address - Street 2:401-E
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5305
Practice Address - Country:US
Practice Address - Phone:248-424-7207
Practice Address - Fax:248-424-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI237461251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237461Medicare ID - Type UnspecifiedHOME HEALTH CARE