Organization
SOUTHPARK SENIOR LIVING LLC
Active
Other names
Place at Southpark Assisted Living and Memory Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON M HARDER (MANAGER)
(503) 375-9016
Entity
Organization
Contact information
Practice address
2101 RUNNYMEDE LN, CHARLOTTE, NC 28209-3316
(704) 525-5508
(704) 525-2672
Mailing address
PO BOX 3006, SALEM, OR 97302-0006
(503) 375-9016
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL060076
NC
311500000X
Alzheimer Center (Dementia Center)
HAL060076
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805207
—
NC
Enumeration date
03/30/2007
Last updated
07/23/2008
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