Entity Details

Basic

Entity Type:
Free Standing NF/SNF (Free Standing NF/SNF)

Medicaid #:
0801555

CCN #:
165210

Occupancy Type:
Beds

Max Occupancy:
42

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
660369

Initial License Date:
06/16/1965

Current License Date:
06/19/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
06/18/2024

Months Since Last Survey:
3

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
701 East Fourth Street

City:
St Ansgar

State:
Iowa

Zip:
50472-0340

Phone:
(641) 713-4912

Fax:
(641) 713-4879

URL:

Administrator/License #:
Kelsy Bundy / 108293

Administrator Email:
kbundy@good-sam.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: