Provider Demographics
NPI:1811232713
Name:SUNDANCE SERVICES CORP
Entity Type:Organization
Organization Name:SUNDANCE SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPY MANNAGER
Authorized Official - Prefix:
Authorized Official - First Name:FIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-265-7702
Mailing Address - Street 1:1919 112TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-3784
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1919 112TH ST SW
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3784
Practice Address - Country:US
Practice Address - Phone:425-513-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility