Provider Demographics
NPI:1093234155
Name:HEART FOUNDATION CO
Entity Type:Organization
Organization Name:HEART FOUNDATION CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-833-8229
Mailing Address - Street 1:6108 JAHNKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-2639
Mailing Address - Country:US
Mailing Address - Phone:804-833-8229
Mailing Address - Fax:
Practice Address - Street 1:4950 JEFFERSON DAVIS HWY STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-3957
Practice Address - Country:US
Practice Address - Phone:804-833-8229
Practice Address - Fax:804-833-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2038261QM0801X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health