BROOKDALE PEACHTREE MC
NPI 1295890309
Assisted Living Facility in Statesville, NC

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

The NPI number for Southern Assisted Living, LLC. is 1295890309. It was assigned to this organization in the NPPES registry on December 27, 2006. The provider is doing business as Brookdale Peachtree Mc.

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

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

Active since December 27, 2006CLIA 34D2021503 · Waiver

2814 PEACHTREE RD, STATESVILLE, NC 28625(704) 872-1946(704) 872-1992 Get Directions Write a Review

NPPES record last updated: April 8, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Brookdale Peachtree Mc NPPES

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

BROOKDALE PEACHTREE MC (NPI 1295890309) is a healthcare organization registered as an assisted living facility in Statesville, North Carolina and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through March 14, 2027 and lists Joanne K Leskowicz, Senior Vice President, as its authorized official.

NPPES Registry Identity

NPI1295890309

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameSOUTHERN ASSISTED LIVING, LLC.

Location Address2814 PEACHTREE RDStatesville, NC 28625-8204

Mailing Address6737 W Washington St, Suite 2300Milwaukee, WI 53214-5647

Phone(704) 872-1946

Fax(704) 872-1992

Organization SubpartYesParent: Brookdale Senior Living Inc

Authorized OfficialJoanne K LeskowiczSenior Vice President · (414) 918-5000

Enumeration DateDecember 27, 2006

Last NPPES UpdateApril 8, 2021

NPPES CertifiedApril 8, 2021

✔ NPI 1295890309 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.

2814 PEACHTREE RD, Statesville, NC 28625

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Other Names 1

Doing Business AsBrookdale Peachtree Mc

Other Identifiers 1

Medicaid7804991NC

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 34D2021503

Brookdale Peachtree Memory Care · Statesville, NC

Active · expires Mar 14, 2027

CLIA Number34D2021503

Laboratory TypeAssisted Living Facility

Certificate Effective DateMarch 15, 2025

Certificate Expiration DateMarch 14, 2027

Laboratory DirectorBrittany Bailey

Laboratory Phone(704) 872-1946

Laboratory LocationBrookdale Peachtree Memory Care2814 Peachtree Road, Statesville, NC 28625

CLIA data matches this NPI record on: Address 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 1295890309. It was assigned to this organization in the NPPES registry on December 27, 2006. The provider is doing business as Brookdale Peachtree Mc.

Where is Southern Assisted Living, LLC. located?

Southern Assisted Living, LLC. is located at 2814 Peachtree Rd, Statesville, NC 28625. The listed phone number is (704) 872-1946.

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 34D2021503) is associated with this NPI, valid through March 14, 2027. 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.