Healthcare Provider Details

I. General information

NPI: 1477477859
Provider Name (Legal Business Name): CAVALIER HOMES LLC CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14315 25TH AVENUE CT E
TACOMA WA
98445-4923
US

IV. Provider business mailing address

14315 25TH AVENUE CT E
TACOMA WA
98445-4923
US

V. Phone/Fax

Practice location:
  • Phone: 253-324-4476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JORDON SHELTON
Title or Position: OWNER
Credential:
Phone: 253-324-4476