Envoy of Fork Union, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

ENVOY OF FORK UNION, LLC

Doing business as

Envoy at the Village

Practice address

4238 James Madison Highway
Fork Union, VA 23055

Phone

(434) 842-2916

NPI assigned

Nov 13, 2008

Last updated

Nov 27, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth Ussery

Title

VP

Phone

(407) 571-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Envoy at the Village Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1043464357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 669",
            "city": "FORK UNION",
            "state": "VA",
            "postal_code": "230550669",
            "telephone_number": "434-842-2916",
            "fax_number": "434-842-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4238 JAMES MADISON HIGHWAY",
            "city": "FORK UNION",
            "state": "VA",
            "postal_code": "23055",
            "telephone_number": "434-842-2916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVOY OF FORK UNION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-13",
        "last_updated": "2023-11-27",
        "certification_date": "2020-05-18",
        "status": "A",
        "authorized_official_last_name": "USSERY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "407-571-1550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043464357",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Concourse Pkwy S Ste 200",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Envoy at the Village",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Envoy at the Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christine Cooper, PTA
• Patricia Lee Dawson, FNP
• Dr Beattie Fork Union Office
• DRS. Weiss Optometrists
• Mackenzie Easton
• Roy Fields III
• Fork Union Family Medicine
• Fork Union Medical Associates Inc
• Fork Union Pharmacy Inc
• Fork Union SNF Operations LLC (Oakhurst Health & Rehabilitation)

• Skilled Nursing Facility in Fork Union, VA
• Providers in Fork Union, VA by specialty
• Skilled Nursing Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.