Healthcare Provider Details

I. General information

NPI: 1164867586
Provider Name (Legal Business Name): SUNRISE CHILDREN'S SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W DIXIE AVE
ELIZABETHTOWN KY
42701
US

IV. Provider business mailing address

300 HOPE ST
MT WASHINGTON KY
40047-7757
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-6841
  • Fax:
Mailing address:
  • Phone: 502-538-1000
  • Fax: 502-538-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number500303
License Number StateKY

VIII. Authorized Official

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