SOUTHERN ASSISTED LIVING, LLC. (NPI# 1174689483) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174689483 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ASSISTED LIVING, LLC. |
| Other Organization Name | SKEET CLUB MANOR |
| Practice Address |
1560 Skeet Club Rd High Point NC 27265-9530 |
| Mailing Address |
6737 W Washington St Suite 2300 Milwaukee WI 53214-5647 |
| Practice Telephone | 3368690301 |
| Enumeration Date | 2006-12-29 |
| 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 | 7803890 | 05 |
| Other Name | Type Code |
|---|---|
| Skeet Club 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 |
| 1093871949 | Southern Assisted Living, LLC. | Assisted Living Facility | 1717 Union Rd, Gastonia, NC 28054-5583 | 2006-12-28 |
| 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 |
1560 SKEET CLUB RD |
| City | HIGH POINT |
| State | NC |
| Zip Code | 27265-9530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467066985 | Rowanty N. Jenkins | Registered Nurse | 4305 Holstein Drive, High Point, NC 27265 | 2020-09-02 |
| 1407355704 | Triad Pediatrics, PC | Pediatrics | 2754 Hwy 68, Suite 111, High Point, NC 27265 | 2018-02-02 |
| 1942730452 | Triad Women's Health and Wellness Center | Obstetrics & Gynecology | 3750 Admiral Dr., Suite 104, High Point, NC 27265 | 2017-06-16 |
| 1992235642 | Gina Cobb Davis | Registered Nurse | 2215 Hickswood Rd., High Point, NC 27265 | 2017-06-15 |
| 1700316395 | Jennifer George | Specialist/Technologist | 3988 Clubhouse Court Apt. 2h, High Point, NC 27265 | 2017-06-15 |
| 1730530510 | Safe Living Solutions | Contractor | 2209 Eastchester Dr., Ste 109, High Point, NC 27265 | 2016-06-23 |
| 1528412087 | Johnette Walser | Social Worker | 2411 Penny Road, Suite 102, High Point, NC 27265 | 2016-04-20 |
| 1093143489 | Debbie Schmitz | Specialist | 801 Lindsay St. Suite E, High Point, NC 27265 | 2013-10-22 |
| 1164786034 | Janice Rene' Swanson | Dietitian, Registered | 4515 Premier Dr Ste 401, High Point, NC 27265 | 2012-06-26 |
| 1053600551 | Lynn Buie Brooks | Counselor | 460 Sandybrooke Dr., High Point, NC 27265 | 2011-04-05 |
| Find all providers in zip 27265 | ||||
| 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 |
|---|---|---|---|---|
| 1184771263 | Elm Villa | Assisted Living Facility | 1915 S Elm St, High Point, NC 27260-8806 | 2007-01-04 |
| 1518023183 | Southern Assisted Living, LLC. | Assisted Living Facility | 201 W Hartley Dr, High Point, NC 27265-2843 | 2006-12-28 |
| 1972669547 | Southern Assisted Living, LLC. | Assisted Living Facility | 1568 Skeet Club Rd, High Point, NC 27265-9530 | 2006-12-28 |
| 1740345842 | Southern Assisted Living, LLC. | Assisted Living Facility | 1564 Skeet Club Rd, High Point, NC 27265-9530 | 2006-12-27 |
| 1538253307 | Providence Place Assisted Living, Inc. | Assisted Living Facility | 630 Whittier Avenue, High Point, NC 27262-7602 | 2006-10-03 |
| 1932208550 | Southland Homes, Inc | Assisted Living Facility | 306 Oakview Road, High Point, NC 27265-2050 | 2006-09-21 |
| 1871875682 | Piedmont Christian Home | Assisted Living Facility | 1510 Deep River Rd, High Point, NC 27265-3448 | 2011-09-16 |
| 1073800421 | Monarch | Assisted Living Facility | 400 Dogwood Cir, High Point, NC 27260-2514 | 2011-07-06 |
| 1730476193 | Monarch | Assisted Living Facility | 3417 Corvair Dr, High Point, NC 27265-1809 | 2011-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629689104 | B&b Assisted Living Care LLC | Assisted Living Facility | 9461 Us Hwy 710s, Rowland, NC 28383 | 2020-08-10 |
| 1306465745 | Cedar Senior Living, LLC. | Assisted Living Facility | 670 Cedar Lake Ln, Clinton, NC 28328-8986 | 2020-04-15 |
| 1003444258 | Trinity Developmental Center, LLC | Assisted Living Facility | 4027 Franklin Meadows Dr, Matthews, NC 28105-6935 | 2020-03-31 |
| 1114562147 | Taylor Care Group, LLC | Assisted Living Facility | 1188 Bertha Wilson Rd, Blanch, NC 27212-9795 | 2019-11-13 |
| 1710528377 | Grace Village Inc | Assisted Living Facility | 501 River Bend Dr., Granite Falls, NC 28630 | 2019-10-04 |
| 1336799246 | Tieshquanna Ciare Richardson | Assisted Living Facility | 312 Kilgo St, Clayton, NC 27520-1651 | 2019-09-13 |
| 1326695404 | Snh Nc Tenant LLC | Assisted Living Facility | 5920 Mcchesney Dr, Charlotte, NC 28269-6238 | 2019-08-22 |
| 1659928174 | Coastal Pointe Senior Living LLC | Assisted Living Facility | 5220 Ocean Hwy W, Shallotte, NC 28470-4006 | 2019-08-20 |
| 1861046674 | A1a-arc of Dunn, LLC | Assisted Living Facility | 217 Jonesboro Rd, Dunn, NC 28334-6240 | 2019-07-30 |
| 1679137665 | Kenzi Care LLC | Assisted Living Facility | 668 Wood Rd, Taylorsville, NC 28681 | 2019-04-25 |
| Find all providers with the same taxonomy | ||||
| City | HIGH POINT |
| Zip Code | 27265 |
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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.