Provider Demographics
NPI:1023174257
Name:FIRST VENTRUE MANAGEMNT INC
Entity type:Organization
Organization Name:FIRST VENTRUE MANAGEMNT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHEMOD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAJANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-230-0714
Mailing Address - Street 1:2906 FLOWERS DR N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8752
Mailing Address - Country:US
Mailing Address - Phone:252-230-0714
Mailing Address - Fax:252-237-5390
Practice Address - Street 1:223 N LUMBER ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1729
Practice Address - Country:US
Practice Address - Phone:252-230-0714
Practice Address - Fax:252-453-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-064-013310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805111Medicaid