NPIMap

Organization Active NPI

Lake Norden SD Skilled Nursing Facility LLC

Doing business as Avantara Lake Norden

  • Skilled Nursing Facility
  • Lake Norden, SD
National Provider Identifier
1538725841
Registry record updated May 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LAKE NORDEN SD SKILLED NURSING FACILITY LLC
Doing business as
Avantara Lake Norden
Practice address
803 Park Street
Lake Norden, SD 57248-0139
Phone
(605) 785-3654
Fax
(605) 785-3578
NPI assigned
May 13, 2019
Last updated
May 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2019

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

Authorized official

Name
Chaim Rajchenbach
Title
Ceo/Principal
Phone
(847) 679-9797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

803 Park Street
Lake Norden, SD 57248-0139

Mailing address

3450 Oakton St
Skokie, IL 60076-2951
Phone (847) 679-9797

Other names 1

  • Avantara Lake Norden Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190828002589 SD Part A Provider - Skilled Nursing Facility 8628306651 Practice locations: Lake Norden, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1538725841. Details of each certification follow.

Skilled nursing facility certification: CCN 435059

Legal name
LAKE NORDEN SD SKILLED NURSING FACILITY, LLC
Doing business as
AVANTARA LAKE NORDEN
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 1, 1991
Last certification
Mar 20, 2025
Beds
50
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Legacy Healthcare
Most recent change of ownership
Jul 1, 2019
Organization structure
LLCProprietary
Enrollment address
803 Park St
Lake Norden, SD 57248
Nursing home name
AVANTARA LAKE NORDEN
Affiliated entity
LEGACY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Avantara Lake NordenCCN 435059 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 1, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5046.8 residents per day on average
Chain
Legacy Healthcare89 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
43D2168203Avantara Lake Norden803 Park St, Lake Norden, SD 57248Certificate of waiverJun 23, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Menachem Shabat Individual Operational/Managerial Control Jul 1, 2019
Managing Control - Governing BodyManager of the Manager Jul 1, 2019
Adp of the SNF Jul 1, 2019
Margaret Grimm Individual Operational/Managerial Control Jul 1, 2019
Adp of the SNF Jul 1, 2019
Chaim Rajchenbach Individual Operational/Managerial Control Jul 1, 2019
Managing Control - Governing BodyManager of the Manager Jul 1, 2019
Adp of the SNF Jul 1, 2019
Individual Indirect Ownership Interest Jul 1, 2019 4.9%
GPN Family Trust U/a/D 4/28/08 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Jul 1, 2019 42.5%
Adp of the SNF Jul 1, 2019
Legacy Healthcare Financial Services LLC Organization, Skokie, IL LLC, For-profit Adp of the SNF Jul 1, 2019
Individual Indirect Ownership Interest Jul 1, 2019 2.6%
Oakway Operations LLC Organization, Skokie, IL LLC 5% Or Greater Direct Ownership Interest Jul 1, 2019 15%
RSM US LLP Organization, Davenport, IA Consulting firm Adp of the SNF Jan 1, 2024
William W Devine Individual Operational/Managerial Control Jul 1, 2019
Adp of the SNF Jul 1, 2019
Individual Indirect Ownership Interest Jul 1, 2019 4.9%
Doros Generation Trust U/a/D 1/3/12 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Jul 1, 2019 42.5%
Adp of the SNF Jul 1, 2019
Individual Indirect Ownership Interest Jul 1, 2019 2.6%
Lake Norden SD Property Holdings, LLC Organization, Skokie, IL LLC 5% Or Greater Security Interest Jul 1, 2019 100%
Adp of the SNF Jul 1, 2019
Truist Bank Organization, Charlotte, NC Financial institution 5% Or Greater Security Interest Apr 1, 2022 100%
Operational/Managerial Control Apr 1, 2022

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 84

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

View all 84

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

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": "1557705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557705600000",
    "number": "1538725841",
    "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": "803 PARK STREET",
            "city": "LAKE NORDEN",
            "state": "SD",
            "postal_code": "572480139",
            "telephone_number": "605-785-3654",
            "fax_number": "605-785-3578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NORDEN SD SKILLED NURSING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-13",
        "last_updated": "2019-05-13",
        "status": "A",
        "authorized_official_last_name": "RAJCHENBACH",
        "authorized_official_first_name": "CHAIM",
        "authorized_official_title_or_position": "CEO/PRINCIPAL",
        "authorized_official_telephone_number": "847-679-9797"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avantara Lake Norden",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Norden, SD

Sources for this page

Verify at the official NPI Registry.