MEDICARE: MAN UP MINISTRIES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP1600X	Pastoral Counselor
4	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1811249451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAN UP MINISTRIES LLC

Provider Business Mailing Address
First Line	:	6704 YELLOWHAMMER PL
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2693
Country	:	US
Telephone Number	:	702-410-5165
Fax Number	:	702-410-5165

Provider Business Practice Location Address
First Line	:	6704 YELLOWHAMMER PL
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2693
Country	:	US
Telephone Number	:	702-410-5165
Fax Number	:	702-410-5165

Authorized Official
Title or Position	:	OWNER / MANAGER
Name	:	MR. ROBERT ANTHONY PEOPLES SR.
Credential	:
Telephone Number	:	702-772-7161

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	10/05/2012

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Directions to “MAN UP MINISTRIES LLC ” Practice Location

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