NPIMap

Organization Active NPI

Southpark Senior Living LLC

Doing business as Place at Southpark Assisted Living and Memory Care

  • Assisted Living Facility
  • Charlotte, NC
National Provider Identifier
1982724100
Registry record updated Jul 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
HAL060076 Issued in NC
Legal business name
SOUTHPARK SENIOR LIVING LLC
Doing business as
Place at Southpark Assisted Living and Memory Care
Practice address
2101 Runnymede LN
Charlotte, NC 28209-3316
Phone
(704) 525-5508
Fax
(704) 525-2672
NPI assigned
Mar 30, 2007
Last updated
Jul 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2008

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

Authorized official

Name
Mr. Jon M Harder
Title
Manager
Phone
(503) 375-9016

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X HAL060076 NC Primary
Alzheimer Center (Dementia Center) 311500000X HAL060076 NC

Addresses

Primary practice location

2101 Runnymede LN
Charlotte, NC 28209-3316

Mailing address

PO Box 3006
Salem, OR 97302-0006
Phone (503) 375-9016

Other identifiers 1

IdentifierTypeStateIssuer
7805207MedicaidNC

Other names 1

  • Place at Southpark Assisted Living and Memory Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Place at Southpark Assisted Living and Memory Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216771200000",
    "number": "1982724100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3006",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973020006",
            "telephone_number": "503-375-9016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 RUNNYMEDE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093316",
            "telephone_number": "704-525-5508",
            "fax_number": "704-525-2672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPARK SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "HARDER",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "503-375-9016",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL060076",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NC",
            "license": "HAL060076",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805207",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Place at Southpark Assisted Living and Memory Care",
            "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 Jul 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.