Entity Details

Basic

Entity Type:
Assisted Living Programs for People with Dementia (ALP/D)

Former Entity Name:
Edencrest at Kettlestone Memory Care

Medicaid #:

CCN #:

Occupancy Type:
Units

Max Occupancy:
40

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
S0485

Initial License Date:
06/01/2024

Current License Date:
06/01/2026

Renewal Cycle:

Entity Type Renewal Cycle(months):
24

Expiration Date:
05/31/2028

Months Since Last Survey:
20

Entity Type Survey Cycle(months):
24

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
805 SE Tallgrass Lane

City:
Waukee

State:
Iowa

Zip:
50263

Phone:
(515) 514-9429

Fax:
(515) 981-2311

URL:

Administrator/License #:
Miah Baum /

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: