Sundance Rehabilitation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SLP006437 Issued in GA

Legal business name

SUNDANCE REHABILITATION

Practice address

1305 Northeast Main Street
Vidalia, GA 30475

Phone

(912) 537-4813

Fax

(912) 537-6238

NPI assigned

May 1, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Holly C Graham, M.ED. CCC-SLP

Title

Speech Language Pathologist

Phone

(912) 537-4813

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1932375763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 464",
            "address_2": "1305 NORTHEAST MAIN STREET",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30475",
            "telephone_number": "912-537-4813",
            "fax_number": "912-537-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 NORTHEAST MAIN STREET",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30475",
            "telephone_number": "912-537-4813",
            "fax_number": "912-537-6238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-01",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "912-537-4813",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.ED. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "SLP006437",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "SLP006437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Jared Staples, MD
• Shannon Lacey Staten, CRNA
• Steven P Hill, MD,PC
• Gillian Josephine Stuart, M.D.
• Hubert McCrary Suber, MD
• Sweet Onion Pharmacy
• John Holmes Talton, DDS
• Tattnall Hospital Company, LLC
• Lillian Taylor
• The Baxley & Appling County Hospital Authority

• Skilled Nursing Facility in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; 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.