Healthcare Provider Details

I. General information

NPI: 1720456403
Provider Name (Legal Business Name): SUNRISE CHILDREN'S SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WEDDINGTON BRANCH RD
PIKEVILLE KY
41501
US

IV. Provider business mailing address

PO BOX 1429
MT WASHINGTON KY
40047-1429
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-7001
  • Fax:
Mailing address:
  • Phone: 502-538-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1031
License Number StateKY

VIII. Authorized Official

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