# ENVOY OF GOOCHLAND, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Envoy at the Meadows
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104079243
- **Authorized official:** KENNETH USSERY (VP)
- **Authorized official phone:** (407) 571-1550

## Contact information

- **Practice address:** 2715 DOGTOWN RD, GOOCHLAND, VA 23063-2424
- **Practice address phone:** (804) 556-4418
- **Mailing address:** 2715 DOGTOWN RD, GOOCHLAND, VA 23063-2424
- **Mailing address phone:** (804) 556-4418
- **Mailing address fax:** (804) 556-4485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/03/2008
- **Last updated:** 11/27/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1104079243 | — | VA |