NPIMap

Organization Active NPI

Sundance Rehabilitation Agency, Inc

Doing business as SunDance Rehabilitation Agency of Missouri

  • Rehabilitation Clinic/Center
  • Ballwin, MO
National Provider Identifier
1407012990
Registry record updated Sep 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
SUNDANCE REHABILITATION AGENCY, INC
Doing business as
SunDance Rehabilitation Agency of Missouri
Practice address
14525 Clayton Rd
Apt #410
Ballwin, MO 63011-2764
Phone
(636) 527-3510
Fax
(636) 527-3510
NPI assigned
Aug 4, 2008
Last updated
Sep 30, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNDANCE REHABILITATION CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2009

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

Authorized official

Name
Sue Gwyn
Title
President Director
Phone
(505) 821-3355

Specialties & licenses 1

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

Addresses

Primary practice location

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

Mailing address

101 Sun Ave NE
Compliance Department
Albuquerque, NM 87109-4373
Phone (505) 468-5604

Other names 1

  • SunDance Rehabilitation Agency of Missouri Doing business as

National Provider Directory

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

Other organizations with this tax ID 12

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1407012990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "address_2": "COMPLIANCE DEPARTMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14525 CLAYTON RD",
            "address_2": "APT #410",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112764",
            "telephone_number": "636-527-3510",
            "fax_number": "636-527-3510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE REHABILITATION AGENCY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNDANCE REHABILITATION CORPORATION",
        "enumeration_date": "2008-08-04",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "GWYN",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "PRESIDENT DIRECTOR",
        "authorized_official_telephone_number": "505-821-3355"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SunDance Rehabilitation Agency of Missouri",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ballwin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.