Healthcare Provider Details

I. General information

NPI: 1891038493
Provider Name (Legal Business Name): SUNRISE CHILDREN'S SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NEW START RD
BRONSTON KY
42518
US

IV. Provider business mailing address

PO BOX 1429
MT WASHINGTON KY
40047-1429
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number0167
License Number StateKY

VIII. Authorized Official

Name: SHARON C' DE BACA
Title or Position: EXECUTIVE ASSISTANT TO PRESIDENT
Credential:
Phone: 502-538-1010