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Organization
SUNDANCE SERVICES CORP
Active
Organization
SUNDANCE SERVICES CORP
Active
Other names
Genesis Rehab Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI FREISINGER O.T. (AREA MANAGER)
(414) 531-5226
Entity
Organization
Contact information
Practice address
107 E BECKERT RD, NEW LONDON, WI 54961-2509
(920) 982-5354
(920) 982-9149
Mailing address
107 E BECKERT RD, NEW LONDON, WI 54961-2509
(920) 982-5354
(920) 982-9149
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
3026-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3026-154
STATE OF WISCONSIN - DSPS LICENSE RENEWAL
WI
05
—
42591500
—
WI
Enumeration date
01/24/2013
Last updated
01/24/2013
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