SUNDANCE REHABILITATION AGENCY, INC (NPI# 1407012990) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407012990 |
| Entity Type | Organization |
| Organization Name | SUNDANCE REHABILITATION AGENCY, INC |
| Other Organization Name | SUNDANCE REHABILITATION AGENCY OF MISSOURI |
| Practice Address |
14525 Clayton Rd Apt #410 Ballwin MO 63011-2764 |
| Mailing Address |
101 Sun Ave Ne Compliance Department Albuquerque NM 87109-4373 |
| Practice Telephone | 6365273510 |
| Practice Fax Number | 6365273510 |
| Mailing Telephone | 5054685604 |
| Mailing Fax Number | 5054684681 |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2009-09-30 |
| Authorized Official Name | SUE GWYN (PRESIDENT DIRECTOR) |
| Authorized Official Telephone | 5058213355 |
| Is Organization Subpart | Y |
| Parent Organization Name | SUNDANCE REHABILITATION CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
MO | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| SunDance Rehabilitation Agency of Missouri | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972929024 | Sundance Rehabilitation Agency, Inc | Clinic/Center | 724 Greene St, Augusta, GA 30901-2359 | 2014-03-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | SUNDANCE REHABILITATION AGENCY, INC. | 101 Sun Ave Ne, Albuquerque, NM 87109 |
| Massachusetts Corporations | SUNDANCE REHABILITATION AGENCY, INC. | 101 E. State Street, Kennett Square, PA 19348 |
| Connecticut Business Registrations | SUNDANCE REHABILITATION AGENCY, INC. | 101 East State Street, Kennett Square, PA 19348 |
| Oklahoma Business Registrations | SUNDANCE REHABILITATION AGENCY, INC. | 101 Sun Ave Ne, Albuquerque, NM 87109 |
| Street Address |
14525 CLAYTON RD APT #410 |
| City | BALLWIN |
| State | MO |
| Zip Code | 63011-2764 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205309234 | Heather Renee Leone | Nurse Practitioner | 452 Sovereign Court Suite A, Ballwin, MO 63011 | 2019-01-02 |
| 1538635297 | Jennifer Lea Nicole O'donnell | Registered Nurse | 13861 Manchester Road, Town and Country, MO 63011 | 2018-10-22 |
| 1285127712 | Genevieve Friedmann | Social Worker | 301 Sovereign Ct Ste 103, Ballwin, MO 63011 | 2018-06-09 |
| 1881187391 | Andrew Cittadino Link | Dentist | 14335 Manchester Road, Ballwin, MO 63011 | 2018-06-08 |
| 1972041283 | Anavan LLC | Durable Medical Equipment & Medical Supplies | 14390 Manchester Rd, Saint Louis, MO 63011 | 2017-02-07 |
| 1780131300 | Autism and Behavioral Spectrum LLC | Day Training, Developmentally Disabled Services | 14733 Clayton Road, Chesterfield, MO 63011 | 2016-09-01 |
| 1265872964 | Eryn Nichole Miner | Behavioral Analyst | 15834 Clayton Road, Ellisville, MO 63011 | 2013-06-27 |
| 1194168765 | Donna Margaret Carrillo | Developmental Therapist | 15834 Clayton Rd., Ellisville, MO 63011 | 2013-04-12 |
| 1891047486 | Ashley Amanda Battaglia | Chiropractor | 15945 Clayton Rd Ste 230c, Ballwin, MO 63011 | 2012-10-08 |
| 1750658480 | Gary Frank Sobocinski | Pharmacist | 4033 Sovereign Court, Ballwin, MO 63011 | 2011-11-23 |
| Find all providers in zip 63011 | ||||
| Taxonomy Code | 261QR0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942524087 | Physical Therapy Spine & Sports Medicine LLC | Clinic/Center | 15425 Manchester Rd, Suite 28, Ballwin, MO 63011-3077 | 2010-03-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265073845 | Arnold Physical Therapy & Sports Medicine LLC | Clinic/Center | 9594 Manchester Rd, Saint Louis, MO 63119-1313 | 2019-10-04 |
| 1790326916 | Arnold Physical Therapy & Sports Medicine LLC | Clinic/Center | 11725 Manchester Rd, Des Peres, MO 63131-4616 | 2019-09-30 |
| 1477101376 | Ssm Select Rehab St. Louis, LLC | Clinic/Center | 33 Winfield Plz, Winfield, MO 63389-3451 | 2019-09-04 |
| 1104474006 | Ssm Select Rehab St. Louis, LLC | Clinic/Center | 508 W Veterans Memorial Pkwy, Warrenton, MO 63383-1046 | 2019-09-04 |
| 1497310932 | Select Physical Therapy Holdings, Inc. | Clinic/Center | 201 Highway 34 West, Marble Hill, MO 63764 | 2019-05-09 |
| 1972020394 | Rehab Care Group East, LLC | Clinic/Center | Primrose Retirement Community Jefferson City, 1214 Freedom Boulevard, Jefferson City, MO 65109 | 2017-08-25 |
| 1548715402 | Specialty Rehab & Wellness | Clinic/Center | 3309 Crystal Lake Dr, Festus, Festus, MO 63028-4274 | 2016-08-22 |
| 1679947774 | Elite Physical Therapy of Creve Coeur LLC | Clinic/Center | 12788 Olive Blvd, Creve Coeur, MO 63141-6211 | 2015-11-30 |
| 1922414028 | Prorehab, PC | Clinic/Center | 8023 W Florissant Ave Ste A, Jennings, MO 63136-1448 | 2014-07-09 |
| 1831442540 | Invigorate Rehab Inc | Clinic/Center | 1722 Olive St Ste 201, Saint Louis, MO 63103-1700 | 2012-10-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.