Entity Details

Basic

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

Medicaid #:
0802447

CCN #:
165325

Occupancy Type:
Beds

Max Occupancy:
55

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
540119

Initial License Date:
02/02/1967

Current License Date:
08/15/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/15/2025

Months Since Last Survey:
9

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1212 South Stuart Street

City:
Sigourney

State:
Iowa

Zip:
52591-1300

Phone:
(641) 622-2142

Fax:
(641) 622-9910

URL:

Administrator/License #:
Anna Engstrom / 116376

Administrator Email:
aengstrom@legacyhc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: