Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Evergreen Assisted Living Community LLC

Organization Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · NPI 1780206250

Evergreen Assisted Living Community LLC is an Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Roanoke, Virginia. Registered with an NPI since 2020.

In the registry since
2020
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4222 Moomaw Ave NW
Roanoke, VA 24017-4314
Phone: (540) 613-0757
Fax: (540) 491-9319
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (primary) Taxonomy 320900000X

Record details

NPI number1780206250
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Patience Odupelu — Owner/ Program Director · (540) 613-0757
Other names Evergreen Group Home Services
NPI enumeratedMay 7, 2020
Last updated in NPPESMay 7, 2020
Certification dateMay 7, 2020
Mailing address4222 Moomaw Ave Nw, Roanoke, VA 24017-4314

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