34D2057998 CLIA NUMBER - BROOKDALE SOUTH PARK

Laboratory Demographics

  • CLIA Code: 34D2057998
  • Facility Name: BROOKDALE SOUTH PARK
  • Facility Address: 5326 PARK ROAD
    CHARLOTTE, NC
    ZIP 28209
  • Facility Phone: 704 553-8700
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: ANDREA FITZGERALD
  • NPI Number: 1306992664
  • Taxonomy: 311500000X - Alzheimer Center (Dementia Center)

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CLIA Record

Field Name Field Value
CLIA Number 34D2057998
LAB Type Assisted Living Facility
Facility Name BROOKDALE SOUTH PARK
Street 5326 PARK ROAD
City CHARLOTTE
State NC
ZIP 28209
Phone 704 553-8700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2025
Certificate Expiration Date 4/25/2027
Facility Type Assisted Living Facility
Lab Director ANDREA FITZGERALD

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This page was last updated on: 9/29/2025