Provider Demographics
NPI:1528240066
Name:NAVI GROUP VENTURE I
Entity type:Organization
Organization Name:NAVI GROUP VENTURE I
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-624-4841
Mailing Address - Street 1:300 WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:MI
Mailing Address - Zip Code:49065-9541
Mailing Address - Country:US
Mailing Address - Phone:269-624-4841
Mailing Address - Fax:
Practice Address - Street 1:48 PARRISH RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-1195
Practice Address - Country:US
Practice Address - Phone:440-599-1999
Practice Address - Fax:440-593-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2261-RCF310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility