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General NPI Number Information
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NPI Number | 1679110506
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Entity Type | Organization
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Legal Business Name | DAVID HERZKA
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 12411 GAYTON RD
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City | RICHMOND
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State | VA
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Zip | 23238-2272
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Country | US
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Telephone | 804-741-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 516 SHADY OAKS TRL
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City | BURLESON
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State | TX
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Zip | 76028-2320
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Country | US
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Telephone | 817-933-5432
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Fax |
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | JULIA KING
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Credential |
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Telephone | 817-933-7582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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