Provider Demographics
NPI:1205096971
Name:SUNDANCE REHABILITATION CORPORATION
Entity type:Organization
Organization Name:SUNDANCE REHABILITATION CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPY PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:REDERER
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:412-653-3242
Mailing Address - Street 1:1400 RIGGS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15129-8917
Mailing Address - Country:US
Mailing Address - Phone:412-653-3242
Mailing Address - Fax:412-655-4178
Practice Address - Street 1:1400 RIGGS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH PARK
Practice Address - State:PA
Practice Address - Zip Code:15129-8917
Practice Address - Country:US
Practice Address - Phone:412-653-3242
Practice Address - Fax:412-655-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP-001698-L310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility