SOUTHERN ASSISTED LIVING, LLC. (NPI# 1356407217) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356407217 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ASSISTED LIVING, LLC. |
| Other Organization Name | REYNOLDA PARK |
| Practice Address |
2980 Reynolda Rd Winston Salem NC 27106-3047 |
| Mailing Address |
6737 W Washington St Suite 2300 Milwaukee WI 53214-5647 |
| Practice Telephone | 3367221617 |
| 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 | 7803888 | 05 |
| Other Name | Type Code |
|---|---|
| Reynolda Park | 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 |
| 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 |
| 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 |
2980 REYNOLDA RD |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27106-3047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437799103 | Tyler Laura Lawrence | Behavioral Analyst | 1959 N Peace, 104, Winston-salem, NC 27106 | 2020-01-10 |
| 1316504624 | Amanda Baker | Behavior Technician | 1959 N Peace Haven Rd, Suite 104, Winston Salem, NC 27106 | 2019-05-22 |
| 1679030316 | Lavonda Williams | Behavior Technician | 1959 N Peace Haven Road, Winston Salem, NC 27106 | 2019-03-01 |
| 1518436708 | Angela Ruth Brown | Physical Therapy Assistant | 190 Moravian Way Drive, Winston-salem, NC 27106 | 2018-11-16 |
| 1407378896 | Applied Family Services of Winston-salem | Early Intervention Provider Agency | 4220 Witherow Rd, Winston Salem, NC 27106 | 2017-07-07 |
| 1750801676 | Julia Ann Horton | Speech-Language Pathologist | 2000 Salemtowne Drive, Winston Salem, NC 27106 | 2017-06-21 |
| 1124548037 | Tyler John Jones | Community Health Worker | 7014 Brandemere Ln. Apt F, Winston Salem, NC 27106 | 2017-06-21 |
| 1396274759 | Jennifer Cui | Social Worker | 3216 Cross Tree Rd, Winston-salem, NC 27106 | 2017-06-08 |
| 1063947802 | Rebecca Jeanette Mclemore | Social Worker | 4401 Providence Ln. #121, Top Priority Care Services, LLC., Winston-salem, NC 27106 | 2017-05-01 |
| 1720529357 | Rising Hope Clinical Assistance, LLC | Community/Behavioral Health | 510 Northgate Park Dr, Winston Salem, NC 27106 | 2017-03-15 |
| Find all providers in zip 27106 | ||||
| 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 |
|---|---|---|---|---|
| 1982031720 | Brookdale Senior Living Communities, Inc. | Assisted Living Facility | 275 S Peace Haven Rd, Winston Salem, NC 27104-4419 | 2013-10-10 |
| 1063759397 | Homestead Hill Retirement Limited Partnership | Assisted Living Facility | 2105 Homestead Hills Drive, Winston Salem, NC 27103-6787 | 2013-01-07 |
| 1619253747 | Wamus Family Care Home | Assisted Living Facility | 1251 Shelter Cv, Winston Salem, NC 27106-4417 | 2011-11-03 |
| 1134340557 | Williams Familly Care | Assisted Living Facility | 812 Efird St, Winston Salem, NC 27105-3818 | 2007-05-01 |
| 1336360759 | Williams Family Care 3 | Assisted Living Facility | 2510 Gilmer Ave, Winston Salem, NC 27105-5159 | 2007-05-01 |
| 1417077587 | Quality Professinal Multiservice, LLC | Assisted Living Facility | 5005 Ohio Ave, Winston Salem, NC 27105-2320 | 2007-03-30 |
| 1689794786 | Dogwood Fch | Assisted Living Facility | 1317 Hattie Ave, Winston Salem, NC 27101-1843 | 2007-03-30 |
| 1386763266 | C.r.t. Golden Lamb Rest Home, Inc. | Assisted Living Facility | 1515 Golden Lamb Ct, Winston Salem, NC 27105-6700 | 2007-03-29 |
| 1306973433 | Kapson Danby, LLC | Assisted Living Facility | 3150 Burke Mill Rd, Winston Salem, NC 27103-6431 | 2007-02-27 |
| 1144356379 | Winston Salem Holdings LLC | Assisted Living Facility | 2900 Reynolds Park Rd, Winston Salem, NC 27107-1653 | 2007-02-23 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27106 |
Please comment or provide details below to improve the information on SOUTHERN ASSISTED LIVING, LLC..
| 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.