NPIMap

Organization Active NPI

Waukon Ia Skilled Nursing Facility, LLC

  • Skilled Nursing Facility
  • Waukon, IA
National Provider Identifier
1942075635
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WAUKON IA SKILLED NURSING FACILITY, LLC
Practice address
960 4TH St NW
Waukon, IA 52172-1059
Phone
(563) 568-3493
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 NU Primary

Addresses

Primary practice location

960 4TH St NW
Waukon, IA 52172-1059

Mailing address

960 4TH St NW
Waukon, IA 52172-1059
Phone (563) 568-3493

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240920000366 IA Part A Provider - Skilled Nursing Facility 9133660954 Practice locations: Waukon, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942075635. Details of each certification follow.

Skilled nursing facility certification: CCN 165338

Legal name
WAUKON IA SKILLED NURSING FACILITY LLC
Doing business as
NORTHGATE CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1997
Last certification
Feb 20, 2025
Beds
50
Ownership / control type
Corporation
Multi-facility organization
Legacy Healthcare
Organization structure
LLCProprietary
Enrollment address
960 4TH St NW
Waukon, IA 52172-1059
Nursing home name
NORTHGATE CARE CENTER
Affiliated entity
LEGACY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Northgate Care CenterCCN 165338 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Aug 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5041.2 residents per day on average
Chain
Legacy Healthcare89 facilities in the chain
Special focus status
SFF Candidate
Penalties (3 years)
1Fines totaling $87,160

Processed by Care Compare on Aug 1, 2026.

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.

Ownership & related parties

All disclosed owners & managing parties 34

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

NameRoleSinceShare
Waukon Ia Property Holdings, LLC Organization, Skokie, IL LLC, For-profit Adp of the SNF Aug 15, 2024
Mindy Houston Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
Larina Heying Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF 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
Adp of the SNF Aug 15, 2024
Jennifer Hedberg Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
Laura Friedenberg 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%
Lou Ann Wikan Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
Menachem Shabat Individual Corporate OfficerPresident Aug 15, 2024
Operational/Managerial Control Aug 15, 2024
Patricia Otterbeck Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
MN8 RH Holdco LLC Organization, Skokie, IL LLC, Holding company Adp of the SNF Aug 15, 2024
Melissa Larson Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
Chaim Rajchenbach Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
Elizabeth Van Veghel Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
David B Schwartz Individual Adp of the SNF Mar 10, 2025
Karla Beasley Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
GPN Family Trust U/a/D 4/28/08 Organization, Skokie, IL Real estate investment trust (REIT) 5% Or Greater Indirect Ownership Interest Aug 15, 2024 45.5%
Bobbie Wierschem Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
Legacy Healthcare Financial Services LLC Organization, Skokie, IL LLC, Management services company, Consulting firm, For-profit Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
Kiley Shear Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF 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
Adp of the SNF Aug 15, 2024
Andrea Love-Steiber Individual Operational/Managerial Control Oct 1, 2024
Adp of the SNF Oct 1, 2024
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
Adp of the SNF 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
Adp of the SNF Aug 15, 2024
Gorgona Propco Holdings LLC Organization, Skokie, IL LLC, Holding company, For-profit Adp of the SNF Aug 15, 2024
Christina Hennager Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF Aug 15, 2024
Cascade Capital Holdings LLC Organization, Skokie, IL LLC, Holding company, For-profit Adp of the SNF Aug 15, 2024
Krystle Jaeger Individual Operational/Managerial Control Aug 15, 2024
Adp of the SNF 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 2

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": "1942075635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 4TH ST NW",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "521721059",
            "telephone_number": "563-568-3493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 4TH ST NW",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "521721059",
            "telephone_number": "563-568-3493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUKON 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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukon, IA

Sources for this page

Verify at the official NPI Registry.