Salem SD Skilled Nursing Facility LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SALEM SD SKILLED NURSING FACILITY LLC

Practice address

500 Colonial Dr
Salem, SD 57058-8719

Phone

(605) 425-2203

Fax

(605) 425-2255

NPI assigned

May 14, 2019

Organization subpart

No

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

Authorized official

Name

Menachem Shabat

Title

Coo/Principal

Phone

(847) 679-9797

Specialties & licenses 1

Addresses

Other names 1

• Avantara Salem Doing business as

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557792000000",
    "number": "1497311559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 OAKTON ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762951",
            "telephone_number": "847-679-9797",
            "fax_number": "847-679-1126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 COLONIAL DR",
            "city": "SALEM",
            "state": "SD",
            "postal_code": "570588719",
            "telephone_number": "605-425-2203",
            "fax_number": "605-425-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM SD SKILLED NURSING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-14",
        "last_updated": "2019-05-14",
        "status": "A",
        "authorized_official_last_name": "SHABAT",
        "authorized_official_first_name": "MENACHEM",
        "authorized_official_title_or_position": "COO/PRINCIPAL",
        "authorized_official_telephone_number": "847-679-9797"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avantara Salem",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ruth E Rotert, PT, DPT
• William J Roth
• Salem Care and Rehabilitation Center LLC
• Salem Drug Incorporated
• Salem Elderly Living LLC
• Bryan L. Schierholz
• Allison Thielsen, DPT
• Amy Lynette Tuschen, MA CCC SLP
• Joni Wagner, PA-C

• All providers in Salem, SD
• Skilled Nursing Facility in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2019; 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.