Provider Demographics
NPI:1114406402
Name:ONE FORTY THREE VENTURES
Entity Type:Organization
Organization Name:ONE FORTY THREE VENTURES
Other - Org Name:RIGHT AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-320-8035
Mailing Address - Street 1:7121 HALCYON PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7702
Mailing Address - Country:US
Mailing Address - Phone:334-320-8035
Mailing Address - Fax:334-517-1045
Practice Address - Street 1:7121 HALCYON PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7702
Practice Address - Country:US
Practice Address - Phone:334-320-8035
Practice Address - Fax:334-517-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care