MEDICARE: ASCENDING DOVE CARE FACILITY, INC

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	610-01-001	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689601031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENDING DOVE CARE FACILITY, INC

Provider Business Mailing Address
First Line	:	2914 FENDALL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-3625
Country	:	US
Telephone Number	:	804-321-1111
Fax Number	:	804-321-0999

Provider Business Practice Location Address
First Line	:	5301 HILL DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-5940
Country	:	US
Telephone Number	:	804-264-5801
Fax Number	:	804-264-5802

Authorized Official
Title or Position	:	PROGRAM ADMINISTRATOR
Name	:	MRS. NICHELLE RUFUS COOPER
Credential	:
Telephone Number	:	804-321-1111

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/04/2021

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