Entity Details

Basic

Entity Type:
HSP-NF (HSP-NF)

Medicaid #:

CCN #:
16E725

Occupancy Type:
Beds

Max Occupancy:
32

Status:
Closed

Close Date:
03/14/2014

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
260131H

Initial License Date:

Current License Date:
01/01/2011

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
01/01/2012

Months Since Last Survey:
154

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
509 North Madison

City:
Bloomfield

State:
Iowa

Zip:
52537-0000

Phone:
(641) 664-2145

Fax:
(641) 664-1669

URL:

Administrator/License #:
DEBORAH HERZBERG /

Administrator Email:
dherzberg@daviscountyhospital.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: