MEDICARE: FIRST VENTURE MANAGEMANET INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	HAL-064-014	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033275268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST VENTURE MANAGEMANET INC

Provider Business Mailing Address
First Line	:	2906 FLOWERS DR N
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27896-8752
Country	:	US
Telephone Number	:	252-230-0714
Fax Number	:	252-237-5390

Provider Business Practice Location Address
First Line	:	222 N LUMBER ST
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1730
Country	:	US
Telephone Number	:	252-230-0714
Fax Number	:	252-459-3343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MAHEMOOD J. RAJANI
Credential	:
Telephone Number	:	252-230-0714

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	08/22/2020

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