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BROOKDALE SKEET CLUB
NPI 1174689483
Assisted Living Facility in High Point, NC

Active since December 29, 2006CLIA 34D2021701 · Waiver
1560 SKEET CLUB RD, HIGH POINT, NC 27265(336) 869-0301(336) 869-0252 Get Directions Write a Review

NPPES record last updated: April 8, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Brookdale Skeet Club NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROOKDALE SKEET CLUB (NPI 1174689483) is a healthcare organization registered as an assisted living facility in High Point, North Carolina and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through October 14, 2026 and lists Joanne K Leskowicz, Senior Vice President, as its authorized official.

NPPES Registry Identity

NPI1174689483
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSOUTHERN ASSISTED LIVING, LLC.
Location Address1560 SKEET CLUB RDHigh Point, NC 27265-9530
Mailing Address6737 W Washington St, Suite 2300Milwaukee, WI 53214-5647
Phone(336) 869-0301
Fax(336) 869-0252
Organization SubpartYesParent: Brookdale Senior Living Inc
Authorized OfficialJoanne K LeskowiczSenior Vice President · (414) 918-5000
Enumeration DateDecember 29, 2006
Last NPPES UpdateApril 8, 2021
NPPES CertifiedApril 8, 2021
✔ NPI 1174689483 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
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.
1560 SKEET CLUB RD, High Point, NC 27265
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Other Names 1

Doing Business AsBrookdale Skeet Club

Other Identifiers 1

Medicaid7804107NC

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2021701

Brookdale Skeet Club · High Point, NC
Active · expires Oct 14, 2026
CLIA Number34D2021701
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 15, 2024
Certificate Expiration DateOctober 14, 2026
Laboratory DirectorElizabeth Newton
Laboratory Phone(336) 869-0301
Laboratory LocationBrookdale Skeet Club1560 Skeet Club Road, High Point, NC 27265
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Assisted Living, LLC.'s NPI number?

The NPI number for Southern Assisted Living, LLC. is 1174689483. It was assigned to this organization in the NPPES registry on December 29, 2006. The provider is doing business as Brookdale Skeet Club.

Where is Southern Assisted Living, LLC. located?

Southern Assisted Living, LLC. is located at 1560 Skeet Club Rd, High Point, NC 27265. The listed phone number is (336) 869-0301.

What is Southern Assisted Living, LLC.'s specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Southern Assisted Living, LLC. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2021701) is associated with this NPI, valid through October 14, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southern Assisted Living, LLC. was last updated on April 8, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.