Provider Demographics
NPI:1538725841
Name:LAKE NORDEN SD SKILLED NURSING FACILITY LLC
Entity type:Organization
Organization Name:LAKE NORDEN SD SKILLED NURSING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJCHENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-9797
Mailing Address - Street 1:3450 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2951
Mailing Address - Country:US
Mailing Address - Phone:847-679-9797
Mailing Address - Fax:847-679-1126
Practice Address - Street 1:803 PARK STREET
Practice Address - Street 2:
Practice Address - City:LAKE NORDEN
Practice Address - State:SD
Practice Address - Zip Code:57248-0139
Practice Address - Country:US
Practice Address - Phone:605-785-3654
Practice Address - Fax:605-785-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility