Entity Details

Basic

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

Medicaid #:
0805408

CCN #:
165202

Occupancy Type:
Beds

Max Occupancy:
70

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
770799

Initial License Date:

Current License Date:
09/17/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
09/17/2026

Months Since Last Survey:
7

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
05/05/2026

Loss of NA Training Expires:
05/05/2028

Contact

Address:
2401 East Eighth Street

City:
Des Moines

State:
Iowa

Zip:
50316-0000

Phone:
(515) 262-9303

Fax:
(402) 442-1315

URL:

Administrator/License #:
Dirk Timm / 118358

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: