Healthcare Provider Details

I. General information

NPI: 1467633107
Provider Name (Legal Business Name): SUNRISE CHILDREN'S SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CUNNINGHAM WAY
DANVILLE KY
40422
US

IV. Provider business mailing address

300 HOPE ST
MT WASHINGTON KY
40047-7757
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-5507
  • Fax: 859-236-7044
Mailing address:
  • Phone: 502-538-1000
  • Fax: 502-538-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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