# ENVOY OF WOODBRIDGE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205089240
- **Authorized official:** KENNETH USSERY (VP)
- **Authorized official phone:** (407) 571-1550

## Contact information

- **Practice address:** 14906 JEFFERSON DAVIS HWY, WOODBRIDGE, VA 22191-4016
- **Practice address phone:** (703) 491-6167
- **Mailing address:** 14906 JEFFERSON DAVIS HWY, WOODBRIDGE, VA 22191-4016
- **Mailing address phone:** (703) 491-6167
- **Mailing address fax:** (703) 491-6969

## 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 | — | 1205089240 | — | VA |
| 05 | — | 4953614 | — | VA |