Provider Demographics
NPI:1932231545
Name:SUNDANCE ACADEMY
Entity Type:Organization
Organization Name:SUNDANCE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-967-7664
Mailing Address - Street 1:12816 E TURQUOISE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5300
Mailing Address - Country:US
Mailing Address - Phone:480-773-7329
Mailing Address - Fax:
Practice Address - Street 1:12816 E TURQUOISE AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5300
Practice Address - Country:US
Practice Address - Phone:480-773-7329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility