MEDICARE: VILLAGE ROOTS COMMUNITY CARE, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1871475640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE ROOTS COMMUNITY CARE, LLC

Provider Business Mailing Address
First Line	:	3711 WESTERRE PKWY STE A
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1470
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 WESTERRE PKWY STE A
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1470
Country	:	US
Telephone Number	:	757-798-4463
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. TONI LEMONS
Credential	:
Telephone Number	:	757-798-4463

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	07/23/2025

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