Organization
REAL LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON HERZOG (MANAGER)
(804) 955-5246
Entity
Organization
Contact information
Practice address
1111 N 25TH ST, RICHMOND, VA 23223-5238
(804) 406-4111
(804) 294-2775
Mailing address
PO BOX 27372, RICHMOND, VA 23261-7372
(804) 406-4111
(804) 294-2775
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
02/03/2026
Last updated
02/03/2026
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