Provider Demographics
NPI:1770358228
Name:DW RAISING PLC
Entity type:Organization
Organization Name:DW RAISING PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-290-0672
Mailing Address - Street 1:17172 BURKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8838
Mailing Address - Country:US
Mailing Address - Phone:602-290-0672
Mailing Address - Fax:
Practice Address - Street 1:17172 BURKSHIRE DR
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-8838
Practice Address - Country:US
Practice Address - Phone:602-290-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty