Healthcare Provider Details

I. General information

NPI: 1942902093
Provider Name (Legal Business Name): HOLON HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 RING RD STE 100
ELIZABETHTOWN KY
42701-7960
US

IV. Provider business mailing address

3540 PUMP RD # 1188
RICHMOND VA
23233-1115
US

V. Phone/Fax

Practice location:
  • Phone: 804-404-6270
  • Fax:
Mailing address:
  • Phone: 804-404-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON HERZOG
Title or Position: PRESIDENT
Credential:
Phone: 804-955-5246