SOUTHERN ASSISTED LIVING, LLC. (NPI# 1417013822) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1417013822 |
Entity Type | Organization |
Organization Name | SOUTHERN ASSISTED LIVING, LLC. |
Other Organization Name | STATESVILLE PLACE |
Practice Address |
2806 Peachtree Rd Statesville NC 28625-8204 |
Mailing Address |
6737 W Washington St Suite 2300 Milwaukee WI 53214-5647 |
Practice Telephone | 7048721946 |
Enumeration Date | 2006-12-29 |
Last Update Date | 2011-04-06 |
Authorized Official Name | MARK OHLENDORF (CO-PRESIDENT) |
Authorized Official Telephone | 4149185000 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NC | 7803880 | 05 |
Other Name | Type Code |
---|---|
Statesville Place | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194881581 | Southern Assisted Living, LLC. | Assisted Living Facility | 3619 S Mebane St, Burlington, NC 27215-5221 | 2006-12-29 |
1548326945 | Southern Assisted Living, LLC. | Assisted Living Facility | 1750 Robinwood Rd, Gastonia, NC 28054-1664 | 2006-12-29 |
1174689483 | Southern Assisted Living, LLC. | Assisted Living Facility | 1560 Skeet Club Rd, High Point, NC 27265-9530 | 2006-12-29 |
1093871949 | Southern Assisted Living, LLC. | Assisted Living Facility | 1717 Union Rd, Gastonia, NC 28054-5583 | 2006-12-28 |
1699831594 | Southern Assisted Living, LLC. | Assisted Living Facility | 611 Brooks St, Wake Forest, NC 27587-2978 | 2006-12-28 |
1427114412 | Southern Assisted Living, LLC. | Assisted Living Facility | 1145 Powell Rd, Lenoir, NC 28645-3655 | 2006-12-28 |
1083770937 | Southern Assisted Living, LLC. | Assisted Living Facility | 17 Regional Dr, Pinehurst, NC 28374-8650 | 2006-12-28 |
1023174687 | Southern Assisted Living, LLC. | Assisted Living Facility | 2441 E Broad St, Statesville, NC 28625-4407 | 2006-12-28 |
1518023183 | Southern Assisted Living, LLC. | Assisted Living Facility | 201 W Hartley Dr, High Point, NC 27265-2843 | 2006-12-28 |
1356407217 | Southern Assisted Living, LLC. | Assisted Living Facility | 2980 Reynolda Rd, Winston Salem, NC 27106-3047 | 2006-12-28 |
Entity Type | Entity Name | Entity Address |
---|---|---|
North Carolina Corporation | Southern Assisted Living, LLC | 111 Westwood Place, Suite 400 , Brentwood, TN 37027-5057 |
Virginia Business Entity | Southern Assisted Living, LLC | 111 WESTWOOD PL STE 400 , BRENTWOOD, TN 37027 |
Street Address |
2806 PEACHTREE RD |
City | STATESVILLE |
State | NC |
Zip Code | 28625-8204 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1821232810 | Arc Therapy Services LLC | Clinic/Center | 2806 Peachtree Rd, Statesville, NC 28625-8204 | 2009-04-22 |
1962534073 | Heidi Rae Adams | Physical Therapist | 2806 Peachtree Rd, Statesville, NC 28625-8204 | 2007-03-12 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1730714163 | Sandra Lourdes Mayta | Counselor | 1450 Fern Creek Drive, Statesville, NC 28625 | 2020-03-05 |
1023643582 | Youngchi Chang Dds Pllc | Dentist | 964 Glenway Ave Ste A, Statesville, NC 28625 | 2020-03-05 |
1538799200 | Nicole-marie Blischak | Dentist | 964 Glenway Dr, Ste A, Statesville, NC 28625 | 2020-01-22 |
1013575257 | Sherry Neilson | Registered Nurse | 524 Signal Hill Rd, Statesville, NC 28625 | 2019-06-03 |
1770904328 | Elinor Kyle Tyner | Counselor | 1206 Museum Road, Statesville, NC 28625 | 2013-12-30 |
1982031001 | Tamiko Bradley | Counselor | 524 Signal Hill Dr Ext, Statesville, NC 28625 | 2013-10-03 |
1487932505 | Nicole Weisner Winecoff | Advanced Practice Midwife | 1420 Fern Creek Drive, Statesville, NC 28625 | 2011-07-22 |
1538461967 | Bethany J Sprague | Nurse Practitioner | 2632 Fines Creek Dr, Statesville, NC 28625 | 2010-11-17 |
1477789147 | Greenbriar Primary Care, Pa | Nurse Practitioner | 308-c Mocksville Highway, Statesville, NC 28625 | 2009-06-08 |
1619122538 | Phasebdevelopment | Substance Abuse Rehabilitation Facility | 113 Bethany Rd, Statesville, NC 28625 | 2008-11-19 |
Find all providers in zip 28625 |
Taxonomy Code | 310400000X |
Grouping | Nursing & Custodial Care Facilities |
Classification | Assisted Living Facility |
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023174687 | Southern Assisted Living, LLC. | Assisted Living Facility | 2441 E Broad St, Statesville, NC 28625-4407 | 2006-12-28 |
1295890309 | Southern Assisted Living, LLC. | Assisted Living Facility | 2814 Peachtree Rd, Statesville, NC 28625-8204 | 2006-12-27 |
1225197239 | Omega Investments Inc | Assisted Living Facility | 1372 Eufola Rd, Statesville, NC 28677 | 2006-12-06 |
1578583381 | Piedmont Village At Statesville, Inc. | Assisted Living Facility | 1902 Ora Dr, Statesville, NC 28625-6343 | 2006-07-21 |
1689239923 | Mill Creek Manor, LLC | Assisted Living Facility | 1902 Ora Dr, Statesville, NC 28625-6343 | 2019-05-02 |
1720313976 | Aurora of Statesville, LLC | Assisted Living Facility | 1902 Ora Dr, Statesville, NC 28625-6343 | 2009-10-06 |
1720264146 | Kyrie Health Properties 1, LLC | Assisted Living Facility | 1902 Ora Dr, Statesville, NC 28625-6343 | 2008-01-16 |
1659580819 | Statesville Assisted Living, LLC | Assisted Living Facility | 2147 Davie Ave, Statesville, NC 28625-9200 | 2007-05-22 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1629689104 | B&b Assisted Living Care LLC | Assisted Living Facility | 9461 Us Hwy 710s, Rowland, NC 28383 | 2020-08-10 |
1306465745 | Cedar Senior Living, LLC. | Assisted Living Facility | 670 Cedar Lake Ln, Clinton, NC 28328-8986 | 2020-04-15 |
1003444258 | Trinity Developmental Center, LLC | Assisted Living Facility | 4027 Franklin Meadows Dr, Matthews, NC 28105-6935 | 2020-03-31 |
1114562147 | Taylor Care Group, LLC | Assisted Living Facility | 1188 Bertha Wilson Rd, Blanch, NC 27212-9795 | 2019-11-13 |
1710528377 | Grace Village Inc | Assisted Living Facility | 501 River Bend Dr., Granite Falls, NC 28630 | 2019-10-04 |
1336799246 | Tieshquanna Ciare Richardson | Assisted Living Facility | 312 Kilgo St, Clayton, NC 27520-1651 | 2019-09-13 |
1326695404 | Snh Nc Tenant LLC | Assisted Living Facility | 5920 Mcchesney Dr, Charlotte, NC 28269-6238 | 2019-08-22 |
1659928174 | Coastal Pointe Senior Living LLC | Assisted Living Facility | 5220 Ocean Hwy W, Shallotte, NC 28470-4006 | 2019-08-20 |
1861046674 | A1a-arc of Dunn, LLC | Assisted Living Facility | 217 Jonesboro Rd, Dunn, NC 28334-6240 | 2019-07-30 |
1679137665 | Kenzi Care LLC | Assisted Living Facility | 668 Wood Rd, Taylorsville, NC 28681 | 2019-04-25 |
Find all providers with the same taxonomy |
City | STATESVILLE |
Zip Code | 28625 |
Please comment or provide details below to improve the information on SOUTHERN ASSISTED LIVING, LLC..
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.