Provider Demographics
NPI:1447025960
Name:FULL SQUARE VENTURES INC
Entity type:Organization
Organization Name:FULL SQUARE VENTURES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAKEIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-968-2813
Mailing Address - Street 1:7520 E INDEPENDENCE BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9446
Mailing Address - Country:US
Mailing Address - Phone:704-968-2813
Mailing Address - Fax:855-299-0955
Practice Address - Street 1:7520 E INDEPENDENCE BLVD STE 180
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-9446
Practice Address - Country:US
Practice Address - Phone:704-968-2813
Practice Address - Fax:855-299-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)