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Organization
SUNDANCE BEHAVIORAL HEALTH CARE, INC
Active
Organization
SUNDANCE BEHAVIORAL HEALTH CARE, INC
Active
Other names
Sundance Behavioral Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
PADMANABHA RAJU INDUKURI (OWNER)
(817) 222-9191
Entity
Organization
Contact information
Practice address
2707 AIRPORT FWY, FORT WORTH, TX 76111-2370
(817) 222-9191
(817) 222-9797
Mailing address
7000 HIGHWAY 287, ARLINGTON, TX 76001-2805
(817) 583-8080
(817) 483-1572
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17889802
—
TX
01
—
TXB135639
MEDICARE
TX
Enumeration date
07/18/2006
Last updated
03/10/2017
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