Provider Demographics
NPI:1982491163
Name:HERO GROUP HOME LLC
Entity type:Organization
Organization Name:HERO GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMITT
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEVELS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:330-518-5384
Mailing Address - Street 1:10613 LAMONTIER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-4847
Mailing Address - Country:US
Mailing Address - Phone:216-716-8659
Mailing Address - Fax:
Practice Address - Street 1:10613 LAMONTIER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-4847
Practice Address - Country:US
Practice Address - Phone:216-716-8659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care