Healthcare Provider Details

I. General information

NPI: 1043464357
Provider Name (Legal Business Name): ENVOY OF FORK UNION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/27/2023
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 JAMES MADISON HIGHWAY
FORK UNION VA
23055
US

IV. Provider business mailing address

PO BOX 669
FORK UNION VA
23055-0669
US

V. Phone/Fax

Practice location:
  • Phone: 434-842-2916
  • Fax:
Mailing address:
  • Phone: 434-842-2916
  • Fax: 434-842-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KENNETH USSERY
Title or Position: VP
Credential:
Phone: 407-571-1550