Provider Demographics
NPI:1073966206
Name:COMMITTED 100 MEN HELPING BOYS
Entity Type:Organization
Organization Name:COMMITTED 100 MEN HELPING BOYS
Other - Org Name:RISING STARS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-462-0316
Mailing Address - Street 1:4550 W OAKEY BLVD
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1581
Mailing Address - Country:US
Mailing Address - Phone:702-462-0316
Mailing Address - Fax:702-462-0317
Practice Address - Street 1:4550 W OAKEY BLVD
Practice Address - Street 2:SUITE 104A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1581
Practice Address - Country:US
Practice Address - Phone:702-462-0316
Practice Address - Fax:702-462-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health