Provider Demographics
NPI:1922130004
Name:SUNRISE, INC,
Entity Type:Organization
Organization Name:SUNRISE, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:BGS, MS
Authorized Official - Phone:620-285-3462
Mailing Address - Street 1:523 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-3053
Mailing Address - Country:US
Mailing Address - Phone:620-285-3462
Mailing Address - Fax:620-285-6881
Practice Address - Street 1:523 MAIN ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-3053
Practice Address - Country:US
Practice Address - Phone:620-285-3462
Practice Address - Fax:620-285-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility