BROOKDALE ELIZABETH CITY
NPI 1659436780
Assisted Living Facility in Elizabeth City, NC

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

The NPI number for Southern Assisted Living, LLC. is 1659436780. It was assigned to this organization in the NPPES registry on December 27, 2006. The provider is doing business as Brookdale Elizabeth City.

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 34D2200671 · Waiver

401 HASTINGS LN, ELIZABETH CITY, NC 27909(252) 333-1171(252) 331-0334 Get Directions Write a Review

NPPES record last updated: April 7, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Brookdale Elizabeth City NPPES

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

BROOKDALE ELIZABETH CITY (NPI 1659436780) is a healthcare organization registered as an assisted living facility in Elizabeth City, North Carolina and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through November 16, 2026 and lists Joanne K Leskowicz, Senior Vice President, as its authorized official.

NPPES Registry Identity

NPI1659436780

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameSOUTHERN ASSISTED LIVING, LLC.

Location Address401 HASTINGS LNElizabeth City, NC 27909-3327

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

Phone(252) 333-1171

Fax(252) 331-0334

Organization SubpartYesParent: Brookdale Senior Living Inc

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

Enumeration DateDecember 27, 2006

Last NPPES UpdateApril 7, 2021

NPPES CertifiedApril 7, 2021

✔ NPI 1659436780 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.

401 HASTINGS LN, Elizabeth City, NC 27909

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Other Names 1

Doing Business AsBrookdale Elizabeth City

Other Identifiers 1

Medicaid7803726NC

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 34D2200671

Brookdale Elizabeth City · Elizabeth City, NC

Active · expires Nov 16, 2026

CLIA Number34D2200671

Laboratory TypeAssisted Living Facility

Certificate Effective DateNovember 17, 2024

Certificate Expiration DateNovember 16, 2026

Laboratory DirectorEmily F. Koury

Laboratory Phone(525) 333-1171

Laboratory LocationBrookdale Elizabeth City401 Hastings Lane, Elizabeth City, NC 27909

CLIA data matches this NPI record on: Address Name

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 1659436780. It was assigned to this organization in the NPPES registry on December 27, 2006. The provider is doing business as Brookdale Elizabeth City.

Where is Southern Assisted Living, LLC. located?

Southern Assisted Living, LLC. is located at 401 Hastings Ln, Elizabeth City, NC 27909. The listed phone number is (252) 333-1171.

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 34D2200671) is associated with this NPI, valid through November 16, 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 7, 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.