Healthcare Provider Details

I. General information

NPI: 1659437218
Provider Name (Legal Business Name): SOUTHERN ASSISTED LIVING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 PATTERSON AVENUE
MONROE NC
28112
US

IV. Provider business mailing address

6737 W WASHINGTON ST SUITE 2300
MILWAUKEE WI
53214-5647
US

V. Phone/Fax

Practice location:
  • Phone: 704-282-0530
  • Fax: 704-296-9058
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JOANNE K LESKOWICZ
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 414-918-5000