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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