NPIMap

Organization Active NPI

Southern Assisted Living, LLC.

Doing business as Brookdale High Point North

  • Assisted Living Facility
  • High Point, NC
National Provider Identifier
1740345842
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
SOUTHERN ASSISTED LIVING, LLC.
Doing business as
Brookdale High Point North
Practice address
1564 Skeet Club Rd
High Point, NC 27265-9530
Phone
(336) 869-4188
Fax
(336) 869-5188
NPI assigned
Dec 27, 2006
Last updated
Apr 7, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
BROOKDALE SENIOR LIVING INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Authorized official

Name
Joanne K Leskowicz
Title
Senior Vice President
Phone
(414) 918-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NU Primary

Addresses

Primary practice location

1564 Skeet Club Rd
High Point, NC 27265-9530

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7804150MedicaidNC

Other names 1

  • Brookdale High Point North 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
34D2018418Brookdale High Point North1564 Skeet Club Road, High Point, NC 27265Certificate of waiverJan 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Abingdon Place42 organizations share this tax ID, including this one
Part of
Brookdale Senior Living Inc

Other organizations with this tax ID 41

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

View all 41

Locations

1564 Skeet Club Rd
High Point, NC 27265
Phone (336) 218-6899

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617753600000",
    "number": "1740345842",
    "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": "1564 SKEET CLUB RD",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272659530",
            "telephone_number": "336-869-4188",
            "fax_number": "336-869-5188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ASSISTED LIVING, LLC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROOKDALE SENIOR LIVING INC",
        "enumeration_date": "2006-12-27",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "LESKOWICZ",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "414-918-5000"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804150",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale High Point North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in High Point, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; 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.