1972668010 NPI number — SOUTHERN ASSISTED LIVING, LLC.

Table of content: (NPI 1972668010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972668010 NPI number — SOUTHERN ASSISTED LIVING, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN ASSISTED LIVING, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BROOKDALE FOREST CITY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972668010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6737 W WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 2300
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53214-5647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
493 PINEY RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28043-9017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-288-1171
Provider Business Practice Location Address Fax Number:
828-288-1178
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7803651 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com