Provider Demographics
NPI:1972666337
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:PO BOX 88
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:207-255-8022
Practice Address - Street 1:4 CLARK ST
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:ME
Practice Address - Zip Code:04631-1036
Practice Address - Country:US
Practice Address - Phone:207-853-4540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME225422320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME115490103Medicaid