1. Home
  2. Directory
  3. North Carolina
  4. Statesville
  5. Assisted Living Facility
  6. NPI Profile

BROOKDALE PEACHTREE AL
NPI 1417013822
Assisted Living Facility in Statesville, NC

Active since December 29, 2006CLIA 34D2021505 · Waiver
2806 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 23, 2026.

About Brookdale Peachtree Al NPPES

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

BROOKDALE PEACHTREE AL (NPI 1417013822) 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

NPI1417013822
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSOUTHERN ASSISTED LIVING, LLC.
Location Address2806 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 29, 2006
Last NPPES UpdateApril 8, 2021
NPPES CertifiedApril 8, 2021
✔ NPI 1417013822 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.
2806 PEACHTREE RD, Statesville, NC 28625
Open in Google Maps ↗

Other Names 1

Doing Business AsBrookdale Peachtree Al

Other Identifiers 1

Medicaid7803880NC

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 34D2021505

Brookdale Peachtree Assisted Living · Statesville, NC
Active · expires Mar 14, 2027
CLIA Number34D2021505
Laboratory TypeAssisted Living Facility
Certificate Effective DateMarch 15, 2025
Certificate Expiration DateMarch 14, 2027
Laboratory DirectorHeather Melton
Laboratory Phone(704) 872-1946
Laboratory LocationBrookdale Peachtree Assisted Living2806 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.

Other Providers at the Same Location NPPES

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

HEIDI RAE ADAMS DPT
Physical Therapist
2806 PEACHTREE RD
STATESVILLE, NC 28625
Iredell County (704) 872-5447

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 1417013822. It was assigned to this organization in the NPPES registry on December 29, 2006. The provider is doing business as Brookdale Peachtree Al.

Where is Southern Assisted Living, LLC. located?

Southern Assisted Living, LLC. is located at 2806 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 34D2021505) 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.