Provider Demographics
NPI:1417100975
Name:SUNDANCE REHAB AGENCY OF PA
Entity Type:Organization
Organization Name:SUNDANCE REHAB AGENCY OF PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-779-6440
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:724-779-6440
Mailing Address - Fax:
Practice Address - Street 1:200 NORTHPOINTE CIR STE 302
Practice Address - Street 2:
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-7861
Practice Address - Country:US
Practice Address - Phone:724-779-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012641L313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility