MEDICARE: CAVALIER HEALTH AND WELLNESS CENTER

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1548696073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAVALIER HEALTH AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	431 KINGSRIDGE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-4955
Country	:	US
Telephone Number	:	804-852-6642
Fax Number	:

Provider Business Practice Location Address
First Line	:	4906 CUTSHAW AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3630
Country	:	US
Telephone Number	:	804-852-6642
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KEISHA D DABNEY
Credential	:
Telephone Number	:	804-852-6642

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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