Provider Demographics
NPI:1821590696
Name:RISE ALL LIVES MATTER
Entity Type:Organization
Organization Name:RISE ALL LIVES MATTER
Other - Org Name:RISE ALL LIVES MATTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HAFLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CEPS
Authorized Official - Phone:269-473-6055
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-0422
Mailing Address - Country:US
Mailing Address - Phone:269-473-6055
Mailing Address - Fax:
Practice Address - Street 1:100 W FERRY ST
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1194
Practice Address - Country:US
Practice Address - Phone:269-473-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services