Provider Demographics
NPI:1093113318
Name:SUNRISE OPPORTUNITIES
Entity Type:Organization
Organization Name:SUNRISE OPPORTUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:CASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-255-0763
Mailing Address - Street 1:26 HADLEY LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0088
Mailing Address - Country:US
Mailing Address - Phone:207-255-8596
Mailing Address - Fax:207-255-6110
Practice Address - Street 1:232 COURT STREET
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04654
Practice Address - Country:US
Practice Address - Phone:207-255-8596
Practice Address - Fax:207-255-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2212124Q00000X, 124Q00000X
ME2297124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty