Provider Demographics
NPI:1720891609
Name:DYNAMIC HEALTHCARE NETWORK LLC
Entity type:Organization
Organization Name:DYNAMIC HEALTHCARE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-677-9928
Mailing Address - Street 1:11357 NUCKOLS RD # 1140
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9350 CASTLE YORK COURT
Practice Address - Street 2:UNIT 2211
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-677-9928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health