Provider Demographics
NPI:1740084896
Name:HOLON HEALTH GREAT LAKES, P.C.
Entity type:Organization
Organization Name:HOLON HEALTH GREAT LAKES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-955-5246
Mailing Address - Street 1:3540 PUMP RD # 1188
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1115
Mailing Address - Country:US
Mailing Address - Phone:804-955-5246
Mailing Address - Fax:
Practice Address - Street 1:5650 S 12TH AVE STE 132
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-3187
Practice Address - Country:US
Practice Address - Phone:877-465-6650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health