Entity Details

Basic

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

Former Entity Name:
Pine Acres Rehabilitation And Care Center Llc

Medicaid #:
0801274

CCN #:
165350

Occupancy Type:
Beds

Max Occupancy:
140

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
770231

Initial License Date:
07/29/1976

Current License Date:
02/01/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
02/01/2026

Months Since Last Survey:
4

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
10/31/2024

Loss of NA Training Expires:
10/30/2026

Contact

Address:
1501 Office Park Road

City:
West Des Moines

State:
Iowa

Zip:
50265-2497

Phone:
(515) 223-1223

Fax:
(515) 223-6345

URL:

Administrator/License #:
Michael Ewalt / 081173

Administrator Email:
MEwalt@pineacrescenter.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: