MEDICARE: NAVI GROUP VENTURE I

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	2261-RCF	OH

General Provider Information

NPI Number	:	1528240066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVI GROUP VENTURE I

Provider Business Mailing Address
First Line	:	300 WHITE OAK RD
Second Line	:
City	:	LAWTON
State	:	MI
Zip	:	49065-9541
Country	:	US
Telephone Number	:	269-624-4841
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 PARRISH RD
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-1195
Country	:	US
Telephone Number	:	440-599-1999
Fax Number	:	440-593-1259

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTOPHER C RANDALL
Credential	:
Telephone Number	:	269-624-4841

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	02/24/2009

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Directions to “NAVI GROUP VENTURE I ” Practice Location

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