Provider Demographics
NPI:1760906390
Name:SUNDANCE HOME CARE INC.
Entity Type:Organization
Organization Name:SUNDANCE HOME CARE INC.
Other - Org Name:SUNDANCE HOME CARE CDPAS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTARTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:METELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-796-1777
Mailing Address - Street 1:504 LIVONIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-5248
Mailing Address - Country:US
Mailing Address - Phone:347-796-1777
Mailing Address - Fax:718-514-6434
Practice Address - Street 1:504 LIVONIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5248
Practice Address - Country:US
Practice Address - Phone:347-796-1777
Practice Address - Fax:718-514-6434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNDANCE HOME CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-26
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04708930Medicaid