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BROOKDALE WAKE FOREST
NPI 1699831594
Assisted Living Facility in Wake Forest, NC

Active since December 28, 2006CLIA 34D2213354 · Waiver
611 BROOKS ST, WAKE FOREST, NC 27587(919) 562-8400(919) 562-4687 Get Directions Write a Review

NPPES record last updated: April 8, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Brookdale Wake Forest NPPES

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

BROOKDALE WAKE FOREST (NPI 1699831594) is a healthcare organization registered as an assisted living facility in Wake Forest, North Carolina and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through February 10, 2027 and lists Joanne K Leskowicz, Senior Vice President, as its authorized official.

NPPES Registry Identity

NPI1699831594
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSOUTHERN ASSISTED LIVING, LLC.
Location Address611 BROOKS STWake Forest, NC 27587-2978
Mailing Address6737 W Washington St, Suite 2300Milwaukee, WI 53214-5647
Phone(919) 562-8400
Fax(919) 562-4687
Organization SubpartYesParent: Brookdale Senior Living Inc
Authorized OfficialJoanne K LeskowiczSenior Vice President · (414) 918-5000
Enumeration DateDecember 28, 2006
Last NPPES UpdateApril 8, 2021
NPPES CertifiedApril 8, 2021
✔ NPI 1699831594 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.
611 BROOKS ST, Wake Forest, NC 27587
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Other Names 1

Doing Business AsBrookdale Wake Forest

Other Identifiers 1

Medicaid7803892NC

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 34D2213354

Brookdale Wake Forest · Wake Forest, NC
Active · expires Feb 10, 2027
CLIA Number34D2213354
Laboratory TypeAssisted Living Facility
Certificate Effective DateFebruary 11, 2025
Certificate Expiration DateFebruary 10, 2027
Laboratory DirectorCharisse M. Fain
Laboratory Phone(919) 562-8400
Laboratory LocationBrookdale Wake Forest611 S Brook St, Wake Forest, NC 27587
CLIA data matches this NPI record on: 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.

MRS. MEG ELIZABETH WILBER COTA/L
Occupational Therapy Assistant
611 BROOKS ST
WAKE FOREST, NC 27587
Wake County (919) 554-4671

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 1699831594. It was assigned to this organization in the NPPES registry on December 28, 2006. The provider is doing business as Brookdale Wake Forest.

Where is Southern Assisted Living, LLC. located?

Southern Assisted Living, LLC. is located at 611 Brooks St, Wake Forest, NC 27587. The listed phone number is (919) 562-8400.

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 34D2213354) is associated with this NPI, valid through February 10, 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.