Healthcare Provider Details

I. General information

NPI: 1356588388
Provider Name (Legal Business Name): ENVOY OF GOOCHLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 DOGTOWN RD
GOOCHLAND VA
23063-2424
US

IV. Provider business mailing address

800 CONCOURSE PKWY S SUITE 200
MAITLAND FL
32751-6152
US

V. Phone/Fax

Practice location:
  • Phone: 804-556-4418
  • Fax: 804-556-4485
Mailing address:
  • Phone: 407-571-1550
  • Fax: 407-571-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH CONTE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 407-571-1550