NPIMap

Organization Active NPI

Sundance Rehabilitation Agency LLC

Doing business as Sundance Georgia Rehabilitation Agency

  • Rehabilitation Clinic/Center
  • Savannah, GA
National Provider Identifier
1376969410
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
SUNDANCE REHABILITATION AGENCY LLC
Doing business as
Sundance Georgia Rehabilitation Agency
Practice address
1 Peachtree Dr
Savannah, GA 31419-1200
Phone
(912) 777-4453
NPI assigned
Mar 13, 2014
Last updated
Jun 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Louise Ann Soika
Title
SVP
Phone
(610) 925-4088

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

1 Peachtree Dr
Savannah, GA 31419-1200

Mailing address

101 E State St
Kennett Square, PA 19348-3109
Phone (724) 831-5044

Other names 1

  • Sundance Georgia Rehabilitation Agency Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140702001104 GA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 5698683498 Practice locations: Savannah, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376969410. Details of each certification follow.

  • CCN 116890 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 116890

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SUNDANCE GEORGIA REHABILITATION AGENCY
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Nov 3, 2014
Last certification
Sep 14, 2021
Ownership / control type
Proprietary
Facility address
1 Peachtree Drive
Savannah, GA 31419

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Sundance Rehabilitation Agency LLC13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1479 Grove Park Dr
Columbus, GA 31904
Phone (706) 222-7188

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1376969410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE ST",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193483109",
            "telephone_number": "724-831-5044",
            "fax_number": "610-612-5459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PEACHTREE DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314191200",
            "telephone_number": "912-777-4453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE REHABILITATION AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-13",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "SOIKA",
        "authorized_official_first_name": "LOUISE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "610-925-4088"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sundance Georgia Rehabilitation Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.