MEDICARE: MEN ON THE RISE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1801166541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEN ON THE RISE

Provider Business Mailing Address
First Line	:	6215 WILDCAT BROOK CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6645
Country	:	US
Telephone Number	:	702-277-6336
Fax Number	:

Provider Business Practice Location Address
First Line	:	6215 WILDCAT BROOK CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6645
Country	:	US
Telephone Number	:	702-277-6336
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CAREY F RODGERS
Credential	:
Telephone Number	:	702-277-6336

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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Directions to “MEN ON THE RISE ” Practice Location

Language	Start Address	Practice Location

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