Healthcare Provider Details

I. General information

NPI: 1447025960
Provider Name (Legal Business Name): FULL SQUARE VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 E INDEPENDENCE BLVD STE 180
CHARLOTTE NC
28227-9446
US

IV. Provider business mailing address

7520 E INDEPENDENCE BLVD STE 180
CHARLOTTE NC
28227-9446
US

V. Phone/Fax

Practice location:
  • Phone: 704-968-2813
  • Fax: 855-299-0955
Mailing address:
  • Phone: 980-306-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: NAKEIBA SMITH
Title or Position: PRESIDENT
Credential:
Phone: 704-968-2813