Healthcare Provider Details

I. General information

NPI: 1407711005
Provider Name (Legal Business Name): VILLAGEGATE CARE COLLECTIVE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 E STATE ROAD 44 STE 12
WILDWOOD FL
34785-7486
US

IV. Provider business mailing address

4076 E STATE ROAD 44 STE 12
WILDWOOD FL
34785-7486
US

V. Phone/Fax

Practice location:
  • Phone: 407-917-0978
  • Fax:
Mailing address:
  • Phone: 407-917-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SAMANTHA FERGUSON WILSON
Title or Position: ADMINSTRATOR
Credential:
Phone: 407-917-0978