Healthcare Provider Details

I. General information

NPI: 1285567073
Provider Name (Legal Business Name): GOGO HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BLUE RIDGE AVE
FRONT ROYAL VA
22630-3005
US

IV. Provider business mailing address

303 BLUE RIDGE AVE
FRONT ROYAL VA
22630-3005
US

V. Phone/Fax

Practice location:
  • Phone: 703-930-9210
  • Fax: 540-930-1484
Mailing address:
  • Phone: 703-930-9210
  • Fax: 540-930-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: LEONARD IKECHUKWU CHUKWUJIOKE MBIHA
Title or Position: AMINISTRATOR
Credential: CCMA MHA
Phone: 703-930-9210