NPIMap

Organization Active NPI

Waukon Ia Skilled Nursing Facility, LLC

Doing business as Southcrest Manor Operator

  • Assisted Living Facility
  • Waukon, IA
National Provider Identifier
1356291546
Registry record updated Jan 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
WAUKON IA SKILLED NURSING FACILITY, LLC
Doing business as
Southcrest Manor Operator
Practice address
602 2ND St SW
Waukon, IA 52172-2242
Phone
(563) 568-4207
NPI assigned
Jan 29, 2026
Last updated
Jan 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2026

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

Authorized official

Name
Menachem Shabat
Title
President
Phone
(847) 679-5331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

602 2ND St SW
Waukon, IA 52172-2242

Mailing address

602 2ND St SW
Waukon, IA 52172-2242

Other names 1

  • Southcrest Manor Operator Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Waukon 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.

NPI Registry JSON

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

{
    "created_epoch": "1769644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769644800000",
    "number": "1356291546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 2ND ST SW",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "521722242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 2ND ST SW",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "521722242",
            "telephone_number": "563-568-4207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUKON IA SKILLED NURSING FACILITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-29",
        "last_updated": "2026-01-29",
        "certification_date": "2026-01-29",
        "status": "A",
        "authorized_official_last_name": "SHABAT",
        "authorized_official_first_name": "MENACHEM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-679-5331"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southcrest Manor Operator",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waukon, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.