NPIMap

Organization Active NPI

Elma Ia Skilled Nursing Facility, LLC

  • Skilled Nursing Facility
  • Elma, IA
National Provider Identifier
1114792892
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ELMA IA SKILLED NURSING FACILITY, LLC
Practice address
407 9TH St
Elma, IA 50628-8217
Phone
(641) 393-2134
NPI assigned
Nov 22, 2023
Last updated
Nov 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chaim Rajchenbach
Title
Principal
Phone
(847) 745-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

407 9TH St
Elma, IA 50628-8217

Mailing address

407 9TH St
Elma, IA 50628-8217
Phone (641) 393-2134

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240918000689 IA Part A Provider - Skilled Nursing Facility 4688115686 Practice locations: Elma, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114792892. Details of each certification follow.

Skilled nursing facility certification: CCN 165386

Legal name
ELMA IA SKILLED NURSING FACILITY LLC
Doing business as
COLONIAL MANOR OF ELMA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1998
Last certification
Feb 13, 2025
Beds
40
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Legacy Healthcare
Organization structure
LLCProprietary
Enrollment address
407 9TH St
Elma, IA 50628-8217
Nursing home name
COLONIAL MANOR OF ELMA
Affiliated entity
LEGACY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Colonial Manor of ElmaCCN 165386 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 1, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4034.4 residents per day on average
Chain
Legacy Healthcare89 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $44,768

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Elma Ia Skilled Nursing Facility LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 36

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mindy Houston Individual Operational/Managerial Control Aug 15, 2024
Larina Heying Individual Operational/Managerial Control Aug 15, 2024
Gorgona Sub Holdco LLC Organization, Skokie, IL LLC, Holding company, For-profit Adp of the SNF Aug 15, 2024
Jenny Borcherding Individual Operational/Managerial Control Aug 15, 2024
Brian Friedman Individual Trustee of the SNF Jan 3, 2012
Jennifer Hedberg Individual Operational/Managerial Control Aug 15, 2024
Lacey Myhre Individual Operational/Managerial Control Aug 15, 2024
Laura Friedenberg Individual Operational/Managerial Control Aug 15, 2024
Calee Andera Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
Iowa Portfolio Opco Holdings LLC Organization, Skokie, IL Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 15, 2024 100%
Menachem Shabat Individual Corporate OfficerPresident Aug 15, 2024
Operational/Managerial Control Aug 15, 2024
Patricia Otterbeck Individual Operational/Managerial Control Aug 15, 2024
MN8 RH Holdco LLC Organization, Skokie, IL LLC, Holding company Adp of the SNF Aug 15, 2024
Rivka Rajchenbach Individual Trustee of the SNF Apr 28, 2008
Melissa Larson Individual Operational/Managerial Control Aug 15, 2024
Chaim Rajchenbach Individual Operational/Managerial Control Aug 15, 2024
Cascade Capital Holdings LLC Organization, Skokie, IL LLC, Holding company, For-profit Adp of the SNF Aug 15, 2024
Elizabeth Van Veghel Individual Operational/Managerial Control Aug 15, 2024
Karla Beasley Individual Operational/Managerial Control Aug 15, 2024
GPN Family Trust U/a/D 4/28/08 Organization, Skokie, IL 5% Or Greater Indirect Ownership Interest Aug 15, 2024 68%
Bobbie Wierschem Individual Operational/Managerial Control Aug 15, 2024
Legacy Healthcare Financial Services LLC Organization, Skokie, IL LLC, Management services company, For-profit Operational/Managerial Control Aug 15, 2024
Kiley Shear Individual Operational/Managerial Control Aug 15, 2024
Oakway Operations LLC Organization, Skokie, IL LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 15, 2024 22.5%
Cascade Capital Partners LLC Organization, Skokie, IL LLC, Holding company, For-profit Adp of the SNF Aug 15, 2024
Dorothy McClure Individual Operational/Managerial Control Aug 15, 2024
Avrum Rajchenbach Individual Trustee of the SNF Apr 28, 2008
Doros Generation Trust U/a/D 1/3/12 Organization, Skokie, IL 5% Or Greater Indirect Ownership Interest Aug 15, 2024 5%
Linsey Behounek Individual Operational/Managerial Control Aug 15, 2024
CCG Gorgona LLC Organization, Skokie, IL LLC, Holding company, For-profit Adp of the SNF Aug 15, 2024
Sheri Burken Individual Operational/Managerial Control Aug 15, 2024
Gorgona Propco Holdings LLC Organization, Skokie, IL LLC, Holding company, For-profit Adp of the SNF Aug 15, 2024
Colin Deford Individual Operational/Managerial Control Jun 1, 2025
Adp of the SNF Jun 1, 2025
Ahuva Shabat Individual Trustee of the SNF Jan 3, 2012
Krystle Jaeger Individual Operational/Managerial Control Aug 15, 2024
Gorgona Holdco LLC Organization, Skokie, IL LLC, Holding company, For-profit Adp of the SNF Aug 15, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 89

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 89

Practitioners & affiliated clinicians

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700611200000",
    "number": "1114792892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 9TH ST",
            "city": "ELMA",
            "state": "IA",
            "postal_code": "506288217",
            "telephone_number": "641-393-2134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 9TH ST",
            "city": "ELMA",
            "state": "IA",
            "postal_code": "506288217",
            "telephone_number": "641-393-2134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELMA IA SKILLED NURSING FACILITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-22",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A",
        "authorized_official_last_name": "RAJCHENBACH",
        "authorized_official_first_name": "CHAIM",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "847-745-7000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elma, IA

Sources for this page

Verify at the official NPI Registry.