Provider Demographics
NPI:1467633107
Name:SUNRISE CHILDREN'S SERVICES, INC.
Entity Type:Organization
Organization Name:SUNRISE CHILDREN'S SERVICES, INC.
Other - Org Name:WOODLAWN PRTF EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT TO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:C' DE BACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-538-1010
Mailing Address - Street 1:300 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7757
Mailing Address - Country:US
Mailing Address - Phone:502-538-1000
Mailing Address - Fax:502-538-1100
Practice Address - Street 1:400 CUNNINGHAM WAY
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-236-5507
Practice Address - Fax:859-236-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100049560Medicaid