MEDICARE: HEALING HEARTS RECOVERY 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1205770898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HEARTS RECOVERY LLC

Provider Business Mailing Address
First Line	:	9613 KRAUSE RD
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6718
Country	:	US
Telephone Number	:	804-223-6962
Fax Number	:	686-277-7738

Provider Business Practice Location Address
First Line	:	9613 KRAUSE RD
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6718
Country	:	US
Telephone Number	:	804-223-6962
Fax Number	:	686-277-7738

Authorized Official
Title or Position	:	EXECUTIVE ADMINISTRATOR
Name	:	RAYSEAN EDWARDS
Credential	:
Telephone Number	:	804-223-6962

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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