MEDICARE: HEARTS FILLED LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1174221931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTS FILLED LLC

Provider Business Mailing Address
First Line	:	132 N SYCAMORE ST # 27
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-3262
Country	:	US
Telephone Number	:	804-955-7332
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 N SYCAMORE ST # 27
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-3262
Country	:	US
Telephone Number	:	804-955-7332
Fax Number	:

Authorized Official
Title or Position	:	CAO
Name	:	THOMAS LEE RIVES
Credential	:
Telephone Number	:	804-955-7332

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	02/25/2026

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Directions to “HEARTS FILLED LLC ” Practice Location

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