Provider Demographics
NPI:1497097562
Name:SUNRISE CHILDREN'S SERVICES, INC.
Entity Type:Organization
Organization Name:SUNRISE CHILDREN'S SERVICES, INC.
Other - Org Name:FAMILY SERVICES MADISONVILLE
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:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-1429
Mailing Address - Country:US
Mailing Address - Phone:502-538-1000
Mailing Address - Fax:
Practice Address - Street 1:190 MADISON SQUARE DR STE B
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2785
Practice Address - Country:US
Practice Address - Phone:270-874-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1395251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100326270Medicaid