=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235943176
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNRISE CHILDREN'S SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2025
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 CUNNINGHAM WAY
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40422-8342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-236-5507
-----------------------------------------------------
Fax | 859-236-7044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1429
-----------------------------------------------------
City | MT WASHINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40047-1429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-538-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE ASSISTANT TO THE PRESIDEN
-----------------------------------------------------
Name | SHARON C' DE BACA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-538-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 323P00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------