Organization · Type 2 NPI

Sundance Rehabilitation Agency, Inc

Rehabilitation Clinic/Center · Ballwin, MO

NPI number 1407012990 Active

Practice location

14525 Clayton Rd, Apt #410
Ballwin, MO 63011-2764

Call (636) 527-3510 Map

Fax (636) 527-3510

Mailing address

101 Sun Ave NE, Compliance Department
Albuquerque, NM 87109-4373

Specialties and licenses

Taxonomy	Code	License
Rehabilitation Clinic/Center Primary	261QR0400X	None listed

Rehabilitation Clinic/Center: Definition to come...

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NPI record

NPI: 1407012990
Entity type: Organization (Type 2)
Issued: Aug 4, 2008
Last updated: Sep 30, 2009
Status: Active
Subpart: Yes of Sundance Rehabilitation Corporation

Other names

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Sundance Rehabilitation Agency of Missouri · doing business as

Authorized official

Sue Gwyn
President Director
(505) 821-3355

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1407012990

Sundance Rehabilitation Agency, Inc's National Provider Identifier is 1407012990, issued on Aug 4, 2008. The primary taxonomy on file is Rehabilitation Clinic/Center (261QR0400X), and the practice location is in Ballwin, MO. The record was last updated on Sep 30, 2009.