SOUTHERN ASSISTED LIVING LLC. NPI 1699831594

NPI Information

  • NPI: 1699831594
  • Provider Name: SOUTHERN ASSISTED LIVING, LLC.
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: BROOKDALE WAKE FOREST
  • CLIA Number: 34D2213354
  • Address: 611 BROOKS ST
    WAKE FOREST, NC
    ZIP 27587
  • Phone: (919) 562-8400

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NPI Details

SOUTHERN ASSISTED LIVING, LLC. is an assisted living facility in Wake Forest, NC. The provider is 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. SOUTHERN ASSISTED LIVING, LLC. NPI is 1699831594. The provider is registered as an organization entity type.
The provider Is Doing Business As Brookdale Wake Forest.

The provider's business location address is:

611 BROOKS ST
WAKE FOREST, NC
ZIP 27587-978
Phone: (919) 562-8400
Fax: (919) 562-4687

The provider's authorized official is Joanne K Leskowicz .
The authorized official title is Senior Vice President and has the following contact phone number (414) 918-5000.

The CLIA number assigned to this NPI record is 34D2213354 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/28/2006 and was last updated on 4/8/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17803892MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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