Healthcare Provider Details

I. General information

NPI: 1174221931
Provider Name (Legal Business Name): HEARTS FILLED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 KRAUSE RD STE 201
CHESTERFIELD VA
23832-6501
US

IV. Provider business mailing address

10109 KRAUSE RD STE 201
CHESTERFIELD VA
23832-6501
US

V. Phone/Fax

Practice location:
  • Phone: 804-955-7332
  • Fax: 804-773-3528
Mailing address:
  • Phone: 804-955-7332
  • Fax: 804-773-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS LEE RIVES
Title or Position: COO
Credential:
Phone: 804-955-7332