SOUTHERN ASSISTED LIVING, LLC. (NPI# 1093871949) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093871949 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ASSISTED LIVING, LLC. |
| Other Organization Name | GASTON MANOR |
| Practice Address |
1717 Union Rd Gastonia NC 28054-5583 |
| Mailing Address |
6737 W Washington St Suite 2300 Milwaukee WI 53214-5647 |
| Practice Telephone | 7048649440 |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2011-04-06 |
| Authorized Official Name | MARK OHLENDORF (CO-PRESIDENT) |
| Authorized Official Telephone | 4149185000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7803884 | 05 |
| Other Name | Type Code |
|---|---|
| Gaston Manor | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194881581 | Southern Assisted Living, LLC. | Assisted Living Facility | 3619 S Mebane St, Burlington, NC 27215-5221 | 2006-12-29 |
| 1548326945 | Southern Assisted Living, LLC. | Assisted Living Facility | 1750 Robinwood Rd, Gastonia, NC 28054-1664 | 2006-12-29 |
| 1417013822 | Southern Assisted Living, LLC. | Assisted Living Facility | 2806 Peachtree Rd, Statesville, NC 28625-8204 | 2006-12-29 |
| 1174689483 | Southern Assisted Living, LLC. | Assisted Living Facility | 1560 Skeet Club Rd, High Point, NC 27265-9530 | 2006-12-29 |
| 1699831594 | Southern Assisted Living, LLC. | Assisted Living Facility | 611 Brooks St, Wake Forest, NC 27587-2978 | 2006-12-28 |
| 1427114412 | Southern Assisted Living, LLC. | Assisted Living Facility | 1145 Powell Rd, Lenoir, NC 28645-3655 | 2006-12-28 |
| 1083770937 | Southern Assisted Living, LLC. | Assisted Living Facility | 17 Regional Dr, Pinehurst, NC 28374-8650 | 2006-12-28 |
| 1023174687 | Southern Assisted Living, LLC. | Assisted Living Facility | 2441 E Broad St, Statesville, NC 28625-4407 | 2006-12-28 |
| 1518023183 | Southern Assisted Living, LLC. | Assisted Living Facility | 201 W Hartley Dr, High Point, NC 27265-2843 | 2006-12-28 |
| 1356407217 | Southern Assisted Living, LLC. | Assisted Living Facility | 2980 Reynolda Rd, Winston Salem, NC 27106-3047 | 2006-12-28 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporation | Southern Assisted Living, LLC | 111 Westwood Place, Suite 400 , Brentwood, TN 37027-5057 |
| Virginia Business Entity | Southern Assisted Living, LLC | 111 WESTWOOD PL STE 400 , BRENTWOOD, TN 37027 |
| Street Address |
1717 UNION RD |
| City | GASTONIA |
| State | NC |
| Zip Code | 28054-5583 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477873370 | Gaston Manor | Assisted Living Facility | 1717 Union Rd, Gastonia, NC 28054-5583 | 2010-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225671423 | Michaela Karsyn Morris | Behavioral Analyst | 2875 Court Dr. B, Gastonia, NC 28054 | 2019-10-21 |
| 1982263810 | Brenda Sue Fox | Occupational Therapist | Brian Center, 969 Cox Rd, Gastonia, NC 28054 | 2019-06-13 |
| 1174096911 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 469 Hospital Drive, Suite B1, Gastonia, NC 28054 | 2019-01-04 |
| 1255801817 | Jarae Mcswain | Counselor | 1558 Union Road, Ste F, Gastonia, NC 28054 | 2018-11-27 |
| 1427549807 | Alterman & Dhillon Charlotte Metro, Pplc | Dentist | 2205 E. Franklin Blvd, Ste 110, Gastonia, NC 28054 | 2018-05-22 |
| 1871083147 | Terrence Lamont Campbell | Dentist | 2641 Court Dr Ste A, Gastonia, NC 28054 | 2018-05-13 |
| 1861995367 | Jefferson and Jefferson LLC. | Respite Care | 945 East 6 Ave, Gastonia, NC 28054 | 2018-03-12 |
| 1790154912 | Tyler Adcock | Pharmacist | 2324 South New Hope Rd, Gastonia, NC 28054 | 2015-09-17 |
| 1922481894 | Alesha Nicole Logan | Nurse Practitioner | 1895 Hoffman Rd Ste A, Gastonia, NC 28054 | 2015-07-09 |
| 1457732596 | Buffie Baker Eller | Counselor | 2005 Flint Lane, Gastonia, NC 28054 | 2015-06-15 |
| Find all providers in zip 28054 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497080279 | Trinity Manor Assisted Living Home | Assisted Living Facility | 705 S Weldon St, Gastonia, NC 28052-3967 | 2009-10-12 |
| 1003012220 | Maggie's Family Care Home Inc. | Assisted Living Facility | 213 Queens Rd, Gastonia, NC 28052-6737 | 2007-06-25 |
| 1053430058 | Lancaster Health Care, Inc. | Assisted Living Facility | 721 N Marietta St, Gastonia, NC 28052-7376 | 2007-03-29 |
| 1518085935 | Luby-jay Inc | Assisted Living Facility | 916 S Marietta St, Gastonia, NC 28054-5405 | 2007-03-26 |
| 1932223971 | Terrace Ridge Assisted Living, Inc | Assisted Living Facility | 1251 E Hudson Blvd, Gastonia, NC 28054-6102 | 2007-03-16 |
| 1477610244 | Harris Enterprise of Nc, Inc Moses Manor, Inc | Assisted Living Facility | 1401 Bradford Heights Rd, Gastonia, NC 28054-6566 | 2007-01-02 |
| 1548326945 | Southern Assisted Living, LLC. | Assisted Living Facility | 1750 Robinwood Rd, Gastonia, NC 28054-1664 | 2006-12-29 |
| 1922046309 | Morningside of Gastonia, LLC | Assisted Living Facility | 2755 Union Rd, Gastonia, NC 28054-7015 | 2006-06-04 |
| 1013903145 | Wellington House | Assisted Living Facility | 850 Majestic Ct, Gastonia, NC 28054-5131 | 2005-09-23 |
| 1730736828 | Snh Nc Tenant LLC | Assisted Living Facility | 2755 Union Rd, Gastonia, NC 28054-7015 | 2019-08-22 |
| Find all providers in GASTONIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.