Entity Details

Basic

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

Former Entity Name:
Glen Haven Home

Medicaid #:
0801365

CCN #:
165530

Occupancy Type:
Beds

Max Occupancy:
69

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
650355

Initial License Date:
12/04/2004

Current License Date:
12/04/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
12/04/2026

Months Since Last Survey:
10

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
06/05/2025

Loss of NA Training Expires:
06/05/2027

Contact

Address:
133 Indian Hills Drive

City:
Glenwood

State:
Iowa

Zip:
51534-1129

Phone:
(712) 302-9016

Fax:
(712) 302-9017

URL:

Administrator/License #:
Julianne Marriott / 84677

Administrator Email:
administrator@glenhavenvillage.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: