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SUMMIT PLACE OF SOUTH PARK
NPI 1578794566
Assisted Living Facility in Charlotte, NC

Active since August 07, 2009CLIA 34D1089193 · Waiver
2101 RUNNYMEDE LN, CHARLOTTE, NC 28209(704) 525-5508(704) 525-2672 Get Directions Write a Review

NPPES record last updated: August 7, 2009. Verified against the NPPES registry weekly; last sync: September 13, 2026.

About Summit Place Of South Park NPPES

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

SUMMIT PLACE OF SOUTH PARK (NPI 1578794566) is a healthcare organization registered as an assisted living facility in Charlotte, North Carolina and active in the NPI registry since August 2009. The organization holds a CLIA Waiver certificate valid through November 22, 2026 and lists Kristi Hickson Anthony, Regional Vp Of Operations, as its authorized official.

NPPES Registry Identity

NPI1578794566
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSUMMIT PLACE OF SOUTH PARK
Location Address2101 RUNNYMEDE LNCharlotte, NC 28209-3316
Mailing Address2101 Runnymede LnCharlotte, NC 28209-3316 · (704) 525-5508 · Fax (704) 525-2672
Phone(704) 525-5508
Fax(704) 525-2672
Organization SubpartNo
Authorized OfficialKristi Hickson AnthonyRegional Vp Of Operations · (704) 689-1406
Enumeration DateAugust 7, 2009
✔ NPI 1578794566 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in NC · HAL-060-096
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.
2101 RUNNYMEDE LN, Charlotte, NC 28209
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Other Identifiers 1

Medicaid7806173NC

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 34D1089193

Summit Place Of South Park · Charlotte, NC
Active · expires Nov 22, 2026
CLIA Number34D1089193
Laboratory TypeAssisted Living Facility
Certificate Effective DateNovember 23, 2024
Certificate Expiration DateNovember 22, 2026
Laboratory DirectorCamilla J. Carpenter- Sherrill
Laboratory Phone(704) 525-5508
Laboratory LocationSummit Place Of South Park2101 Runnymede Lane, 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 2

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

SNH SE TENANT TRS, INC
Assisted Living Facility
2101 RUNNYMEDE LN
CHARLOTTE, NC 28209
Mecklenburg County (704) 525-5508
SOUTHPARK SENIOR LIVING LLC
Assisted Living Facility
2101 RUNNYMEDE LN
CHARLOTTE, NC 28209
Mecklenburg County (704) 525-5508

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 Summit Place Of South Park's NPI number?

The NPI number for Summit Place Of South Park is 1578794566. It was assigned to this organization in the NPPES registry on August 7, 2009.

Where is Summit Place Of South Park located?

Summit Place Of South Park is located at 2101 Runnymede Ln, Charlotte, NC 28209. The listed phone number is (704) 525-5508.

What is Summit Place Of South Park's specialty?

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

Does Summit Place Of South Park hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D1089193) is associated with this NPI, valid through November 22, 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 Summit Place Of South Park was last updated on August 7, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.