Healthcare Provider Details

I. General information

NPI: 1487955852
Provider Name (Legal Business Name): MEN THAT WIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5828 MARIA DEL MAR ST
LAS VEGAS NV
89130-7299
US

IV. Provider business mailing address

5828 MARIA DEL MAR ST
LAS VEGAS NV
89130-7299
US

V. Phone/Fax

Practice location:
  • Phone: 702-578-6779
  • Fax: 702-925-4775
Mailing address:
  • Phone: 702-578-6779
  • Fax: 702-925-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN DARVELL SANFORD
Title or Position: CEO
Credential: J.D.
Phone: 702-578-6779