Entity Details

Evergreen Estates I ( RCF )

Basic

Entity Type:
Residential Care Facilities (RCF)

Medicaid #:

CCN #:

Occupancy Type:
Beds

Max Occupancy:
50

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
570002

Initial License Date:
01/01/1994

Current License Date:
01/02/2026

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
01/02/2027

Months Since Last Survey:
4

Entity Type Survey Cycle(months):
30

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
3410 12th Avenue SW

City:
Cedar Rapids

State:
Iowa

Zip:
52404-1307

Phone:
(319) 396-3692

Fax:
(319) 396-3540

URL:

Administrator/License #:
Kathy Ely /

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

No Files Found

Licensure Rule Variance:

No Files Found