Healthcare Provider Details

I. General information

NPI: 1033790175
Provider Name (Legal Business Name): SUNRISE CHILDREN'S SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 NEW START RD
BRONSTON KY
42518-8572
US

IV. Provider business mailing address

300 HOPE ST
MT WASHINGTON KY
40047-7757
US

V. Phone/Fax

Practice location:
  • Phone: 606-561-5797
  • Fax:
Mailing address:
  • Phone: 502-538-1000
  • Fax: 502-538-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE N MERTZ
Title or Position: OPERATIONS ANALYST
Credential:
Phone: 502-538-1000