Provider Demographics
NPI:1962776443
Name:SUNDANCE REHABILITATION
Entity type:Organization
Organization Name:SUNDANCE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:HONCHELL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC-SLP
Authorized Official - Phone:513-505-2323
Mailing Address - Street 1:7300 WOODSPOINT DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1543
Mailing Address - Country:US
Mailing Address - Phone:859-283-1346
Mailing Address - Fax:859-980-1444
Practice Address - Street 1:7300 WOODSPOINT DRIVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-283-1346
Practice Address - Fax:859-980-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1938320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY185090Medicare UPIN