Provider Demographics
NPI:1881008597
Name:SUNRISE CHILDREN'S SERVICES, INC.
Entity Type:Organization
Organization Name:SUNRISE CHILDREN'S SERVICES, INC.
Other - Org Name:OWENSBORO FAMILY SERVICES
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:502-538-1100
Practice Address - Street 1:1925 FREDERICA ST STE 200
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-926-2484
Practice Address - Fax:270-685-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100326270Medicaid