Entity Details

Basic

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

Medicaid #:
0805325

CCN #:
165295

Occupancy Type:
Beds

Max Occupancy:
41

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
790180

Initial License Date:

Current License Date:
08/01/2026

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/01/2027

Months Since Last Survey:
6

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
316 Meadow Lane Drive

City:
Montezuma

State:
Iowa

Zip:
50171-1114

Phone:
(641) 219-4330

Fax:
(641) 623-2297

URL:

Administrator/License #:
Mitchell Huff / 114449

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: