Organization
SUNDANCE REHABILITATION LLC
Active
Parent organization
SUNDANCE REHABILITATION CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNDANCE REHABILITATION CORPORATION
Authorized official
CARL ANTHONY SHROM (CEO)
(215) 896-0422
Entity
Organization
Contact information
Practice address
102B KINGS WAY W, SEWELL, NJ 08080-2235
(856) 582-4500
Mailing address
101 E STATE STREET, C/O AMY NUNEMAKER, KENNETT SQUARE, PA 19348-3109
(610) 925-4560
(610) 347-4147
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
N/A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1090113
HORIZON MERCY
—
01
—
2671079
CIGNA
—
01
—
343406
BC/BS
—
01
—
46101
ORTHONET
—
01
—
558970
AETNA US HEALTHCARE
—
01
—
602638
KEYSTONE HP EAST
—
01
—
744645
AMERIHEALTH
—
01
—
C4306
AMERIHEALTH ADMIN.
—
01
—
OK8006
HEALTHNET
—
01
—
QA9881
EMPIRE
—
01
—
SU343406
PENN BS
—
Enumeration date
05/24/2006
Last updated
05/03/2023
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