NPIMap

Organization Active NPI

Waterloo Skilled Nursing Facility LLC

Doing business as Harmony Waterloo

  • Skilled Nursing Facility
  • Waterloo, IA
National Provider Identifier
1679287742
Registry record updated Sep 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WATERLOO SKILLED NURSING FACILITY LLC
Doing business as
Harmony Waterloo
Practice address
201 W Ridgeway Ave
Waterloo, IA 50701-4235
Phone
(319) 234-7777
NPI assigned
Jan 12, 2023
Last updated
Sep 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2023

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) 676-5331

Specialties & licenses 1

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

Addresses

Primary practice location

201 W Ridgeway Ave
Waterloo, IA 50701-4235

Mailing address

3450 Oakton St
Skokie, IL 60076-2951

Other names 1

  • Harmony Waterloo Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230714002457 IA Part A Provider - Skilled Nursing Facility 0446610901 Practice locations: Waterloo, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679287742. Details of each certification follow.

Skilled nursing facility certification: CCN 165034

Legal name
WATERLOO SKILLED NURSING FACILITY LLC
Doing business as
HARMONY WATERLOO
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 19, 1967
Last certification
Jan 15, 2025
Beds
88
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Legacy Healthcare
Organization structure
LLCProprietary
Incorporated
Dec 13, 2022 in IA
Enrollment address
201 W Ridgeway Ave
Waterloo, IA 50701-4235
Nursing home name
HARMONY WATERLOO
Affiliated entity
LEGACY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Harmony WaterlooCCN 165034 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 19, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8874.5 residents per day on average
Chain
Legacy Healthcare89 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $95,440

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
16D0676523Harmony Waterloo201 West Ridgeway Avenue, Waterloo, IA 50701Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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 Corporate OfficerPresident Apr 1, 2023
Justin R Knapp Individual W-2 Managing Employee Mar 29, 2023
GPN Family Trust U/a/D 4/28/08 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Apr 1, 2023 59.5%
Legacy Healthcare Financial Services LLC Organization, Skokie, IL LLC, Management services company, For-profit Operational/Managerial Control Apr 1, 2023
Oakway Operations LLC Organization, Skokie, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Apr 1, 2023 15%
Doros Generation Trust U/a/D 1/3/12 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Apr 1, 2023 25.5%

Facilities with the same owner 89

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

View all 89

NPI Registry JSON

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

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695340800000",
    "number": "1679287742",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W RIDGEWAY AVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507014235",
            "telephone_number": "319-234-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERLOO SKILLED NURSING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A",
        "authorized_official_last_name": "SHABAT",
        "authorized_official_first_name": "MENACHEM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-676-5331"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harmony Waterloo",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Harmony Waterloo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.