Sundance Services Corp

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3026-154 Issued in WI

Legal business name

SUNDANCE SERVICES CORP

Practice address

107 E Beckert Rd
New London, WI 54961-2509

Phone

(920) 982-5354

Fax

(920) 982-9149

NPI assigned

Jan 24, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Lori Freisinger, O.T.

Title

Area Manager

Phone

(414) 531-5226

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Genesis Rehab Services Doing business as

Tax ID family

Genesis Rehab Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Sundance Services Corp

  • Skilled Nursing Facility
  • Everett, WA
  • NPI 1811232713
  NPD tax ID

Locations

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

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358985600000",
    "number": "1902144074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E BECKERT RD",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612509",
            "telephone_number": "920-982-5354",
            "fax_number": "920-982-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E BECKERT RD",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612509",
            "telephone_number": "920-982-5354",
            "fax_number": "920-982-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-24",
        "last_updated": "2013-01-24",
        "status": "A",
        "authorized_official_last_name": "FREISINGER",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "AREA MANAGER",
        "authorized_official_telephone_number": "414-531-5226",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "O.T."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "3026-154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF WISCONSIN - DSPS LICENSE RENEWAL",
            "identifier": "3026-154",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42591500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Rehab Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Joann Spiller, NP
• Nicholas John Sprangers, PHARMD
• St Joseph Residence Inc
• Pamela J. St. Clair, P.T.
• St. Joseph Residence, Inc. - the Washington Center
• Craig E Sylte, O.D.
• Mark Alan Tegtmeier, MA, LCSW, LPC, LMFT
• Marcella K Teske, APNP
• The Pharmacy of New London Inc.
• Thedacare Medical Center - New London, Inc

• Skilled Nursing Facility in New London, WI
• Providers in New London, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; 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.