Provider Demographics
NPI:1922361310
Name:SUNDANCE REHABILITATION AGENCY, INC.
Entity Type:Organization
Organization Name:SUNDANCE REHABILITATION AGENCY, INC.
Other - Org Name:SUNDANCE REHABILITATION AGENCY OF NEW HAMPSHIRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GWYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-279-0201
Mailing Address - Street 1:101 SUN AVE NE DEPT REHAB
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4373
Mailing Address - Country:US
Mailing Address - Phone:505-468-5604
Mailing Address - Fax:505-468-4681
Practice Address - Street 1:17 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4859
Practice Address - Country:US
Practice Address - Phone:603-772-5251
Practice Address - Fax:603-778-1024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN HEALTHCARE GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation