NPIMap

Organization Active NPI

Brea Charlotte, LLC

Doing business as Brookdale South Park

  • Alzheimer Center (Dementia Center)
  • Charlotte, NC
National Provider Identifier
1306992664
Registry record updated May 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Alzheimer Center (Dementia Center)Taxonomy code 311500000X
License
HAL-060-085 Issued in NC
Legal business name
BREA CHARLOTTE, LLC
Doing business as
Brookdale South Park
Practice address
5326 Park Rd
Charlotte, NC 28209-3648
Phone
(704) 553-8700
Fax
(704) 553-8922
NPI assigned
Jan 26, 2007
Last updated
May 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bryan Richardson
Title
Evp, Chief Admin. Officer
Phone
(615) 564-8131

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X HAL-060-085 NC
Alzheimer Center (Dementia Center) 311500000X HAL-060-085 NC Primary

Addresses

Primary practice location

5326 Park Rd
Charlotte, NC 28209-3648

Mailing address

6737 W Washington St
Suite 2300
Milwaukee, WI 53214-5647

Other names 1

  • Brookdale South Park Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2057998Brookdale South Park5326 Park Road, Charlotte, NC 28209Certificate of waiverApr 25, 2027

National Provider Directory

National Provider Directory
Tax ID family
Brea Palmer Ranch LLC25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463356800000",
    "number": "1306992664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6737 W WASHINGTON ST",
            "address_2": "SUITE 2300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532145647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5326 PARK RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093648",
            "telephone_number": "704-553-8700",
            "fax_number": "704-553-8922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREA CHARLOTTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2016-05-16",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "EVP, CHIEF ADMIN. OFFICER",
        "authorized_official_telephone_number": "615-564-8131"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-060-085",
            "primary": false
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NC",
            "license": "HAL-060-085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale South Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.