=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144489071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2008
-----------------------------------------------------
Last Update Date | 06/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1806 CREIGHTON RD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23223-5412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-643-1548
-----------------------------------------------------
Fax | 804-643-8770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1806 CREIGHTON RD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23223-5412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-643-1548
-----------------------------------------------------
Fax | 804-643-8770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. DAWOUD ADEYOLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-643-1548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------