1285815928 NPI number — SUNRISE CHILDREN'S SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285815928 NPI number — SUNRISE CHILDREN'S SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNRISE CHILDREN'S SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WOODLAWN PRTF WEST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285815928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 HOPE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT WASHINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40047-7757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-538-1000
Provider Business Mailing Address Fax Number:
502-538-1100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 CUNNINGHAM WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-236-5507
Provider Business Practice Location Address Fax Number:
859-236-7044
Provider Enumeration Date:
11/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MERTZ
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OPERATIONS ANALYST
Authorized Official Telephone Number:
502-538-1000

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  950017 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100053350 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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