Healthcare Provider Details

I. General information

NPI: 1548088495
Provider Name (Legal Business Name): HERO CRISIS RESIDENTIAL HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 04/20/2025
Certification Date: 04/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 BARBOURSVILLE LN APT 1A
NORTH CHESTERFIELD VA
23234-0027
US

IV. Provider business mailing address

PO BOX 83
CHESTERFIELD VA
23832-0001
US

V. Phone/Fax

Practice location:
  • Phone: 804-243-0637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANTE THOMPSON
Title or Position: DIRECTOR
Credential:
Phone: 804-243-0637