Healthcare Provider Details

I. General information

NPI: 1497685044
Provider Name (Legal Business Name): AWAKENED HEARTS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 W SHAW AVE STE 123
FRESNO CA
93711-3412
US

IV. Provider business mailing address

2350 W SHAW AVE STE 123
FRESNO CA
93711-3412
US

V. Phone/Fax

Practice location:
  • Phone: 559-978-4484
  • Fax:
Mailing address:
  • Phone: 559-978-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN FEDELE III
Title or Position: PRESIDENT
Credential: SUDRC
Phone: 559-978-4484