Provider Demographics
NPI:1821863515
Name:SAC CITY IA SKILLED NURSING FACILITY, LLC
Entity Type:Organization
Organization Name:SAC CITY IA SKILLED NURSING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJCHENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-745-7000
Mailing Address - Street 1:601 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAC CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50583-2429
Mailing Address - Country:US
Mailing Address - Phone:712-662-3818
Mailing Address - Fax:
Practice Address - Street 1:601 PARK AVE
Practice Address - Street 2:
Practice Address - City:SAC CITY
Practice Address - State:IA
Practice Address - Zip Code:50583-2429
Practice Address - Country:US
Practice Address - Phone:712-662-3818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility