Entity Details

Basic

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

Medicaid #:
0808253

CCN #:
165345

Occupancy Type:
Beds

Max Occupancy:
90

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
770185

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:
12

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
5800 NE 12th Avenue

City:
Pleasant Hill

State:
Iowa

Zip:
50327-7228

Phone:
(515) 265-5348

Fax:
(515) 265-0498

URL:

Administrator/License #:
Sharon Despain / 090137

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: