Provider Demographics
NPI:1336414150
Name:SUNRISE POINT
Entity Type:Organization
Organization Name:SUNRISE POINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ADULT FAMILY HOME
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-572-0839
Mailing Address - Street 1:309 CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53949-9100
Mailing Address - Country:US
Mailing Address - Phone:608-572-0839
Mailing Address - Fax:
Practice Address - Street 1:212 CARRIAGE RD
Practice Address - Street 2:
Practice Address - City:MONTELLO
Practice Address - State:WI
Practice Address - Zip Code:53949-9136
Practice Address - Country:US
Practice Address - Phone:608-572-0839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0013722172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty