BROOKDALE SOUTH PARK
NPI 1306992664
Alzheimer Center (Dementia Center) in Charlotte, NC

Q: What is Brea Charlotte, LLC's NPI number?

The NPI number for Brea Charlotte, LLC is 1306992664. It was assigned to this organization in the NPPES registry on January 26, 2007. The provider is doing business as Brookdale South Park.

Q: What is Brea Charlotte, LLC's specialty?

The primary specialty registered for this NPI is Alzheimer Center (Dementia Center) with taxonomy code 311500000X.

Active since January 26, 2007CLIA 34D2057998 · Waiver

5326 PARK RD, CHARLOTTE, NC 28209(704) 553-8700(704) 553-8922 Get Directions Write a Review

NPPES record last updated: May 16, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Brookdale South Park NPPES

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

BROOKDALE SOUTH PARK (NPI 1306992664) is a healthcare organization registered as an alzheimer center (dementia center) in Charlotte, North Carolina and active in the NPI registry since January 2007. The organization holds a CLIA Waiver certificate valid through April 25, 2027 and lists Bryan Richardson, Evp, Chief Admin. Officer, as its authorized official.

NPPES Registry Identity

NPI1306992664

Entity TypeOrganization

Primary Taxonomy311500000X

Legal Business NameBREA CHARLOTTE, LLC

Location Address5326 PARK RDCharlotte, NC 28209-3648

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

Phone(704) 553-8700

Fax(704) 553-8922

Organization SubpartNo

Authorized OfficialBryan RichardsonEvp, Chief Admin. Officer · (615) 564-8131

Enumeration DateJanuary 26, 2007

Last NPPES UpdateMay 16, 2016

✔ NPI 1306992664 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAlzheimer Center (Dementia Center)Nursing & Custodial Care Facilities

Taxonomy Code311500000X

License✔ Licensed in NC · HAL-060-085

Definition

A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer's Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y): Admission of residents with dementia (including those with Alzheimer's disease); Staff who are specially selected, trained, and supervised; Activities that are specifically designed for the cognitively impaired; A marketing of a special care unit in brochures; A high level of family involvement; and A physical environment designed to keep residents safe and segregated from other populations.

Also ListedAssisted Living FacilityTaxonomy 310400000X · License HAL-060-085 (NC)

5326 PARK RD, Charlotte, NC 28209

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Other Names 1

Doing Business AsBrookdale South Park

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 34D2057998

Brookdale South Park · Charlotte, NC

Active · expires Apr 25, 2027

CLIA Number34D2057998

Laboratory TypeAssisted Living Facility

Certificate Effective DateApril 26, 2025

Certificate Expiration DateApril 25, 2027

Laboratory DirectorAndrea Fitzgerald

Laboratory Phone(704) 553-8700

Laboratory LocationBrookdale South Park5326 Park Road, Charlotte, NC 28209

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MAUREEN HOLDEN OT

Occupational Therapist

5326 PARK RD
CHARLOTTE, NC 28209

Mecklenburg County (704) 553-8700

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 Brea Charlotte, LLC's NPI number?

The NPI number for Brea Charlotte, LLC is 1306992664. It was assigned to this organization in the NPPES registry on January 26, 2007. The provider is doing business as Brookdale South Park.

Where is Brea Charlotte, LLC located?

Brea Charlotte, LLC is located at 5326 Park Rd, Charlotte, NC 28209. The listed phone number is (704) 553-8700.

What is Brea Charlotte, LLC's specialty?

The primary specialty registered for this NPI is Alzheimer Center (Dementia Center) with taxonomy code 311500000X.

Does Brea Charlotte, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2057998) is associated with this NPI, valid through April 25, 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 Brea Charlotte, LLC was last updated on May 16, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.