Provider Demographics
NPI:1649317736
Name:SUNNY ENTERPRISE INC
Entity type:Organization
Organization Name:SUNNY ENTERPRISE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-425-4726
Mailing Address - Street 1:8700 WESTPORT RD
Mailing Address - Street 2:SUITE #112
Mailing Address - City:LOU
Mailing Address - State:KY
Mailing Address - Zip Code:40242
Mailing Address - Country:US
Mailing Address - Phone:502-425-4726
Mailing Address - Fax:502-425-7560
Practice Address - Street 1:8700 WESTPORT RD # SU112
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242-3100
Practice Address - Country:US
Practice Address - Phone:502-425-4726
Practice Address - Fax:502-425-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33000365Medicaid