# BREA CHARLOTTE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Brookdale South Park
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306992664
- **Authorized official:** BRYAN RICHARDSON (EVP, CHIEF ADMIN. OFFICER)
- **Authorized official phone:** (615) 564-8131

## Contact information

- **Practice address:** 5326 PARK RD, CHARLOTTE, NC 28209-3648
- **Practice address phone:** (704) 553-8700
- **Practice address fax:** (704) 553-8922
- **Mailing address:** 6737 W WASHINGTON ST, SUITE 2300, MILWAUKEE, WI 53214-5647

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | HAL-060-085 | NC | — |
| 311500000X | Alzheimer Center (Dementia Center) | HAL-060-085 | NC | Yes |

## Other

- **Enumeration date:** 01/26/2007
- **Last updated:** 05/16/2016