MEDICARE: NORTON SD SKILLED NURSING FACILITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1700433703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTON SD SKILLED NURSING FACILITY LLC

Provider Business Mailing Address
First Line	:	3450 OAKTON ST
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-2951
Country	:	US
Telephone Number	:	847-679-9797
Fax Number	:	847-679-1126

Provider Business Practice Location Address
First Line	:	3600 S NORTON AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-6331
Country	:	US
Telephone Number	:	605-338-9891
Fax Number	:	605-338-0332

Authorized Official
Title or Position	:	COO/PRINCIPAL
Name	:	MENACHEM SHABAT
Credential	:
Telephone Number	:	847-679-9797

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	08/23/2019

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