Entity Details

Basic

Entity Type:
Residential Care Facilities (RCF)

Former Entity Name:
Evergreen Estates Iii

Medicaid #:

CCN #:

Occupancy Type:
Beds

Max Occupancy:
50

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
570492

Initial License Date:
06/26/2001

Current License Date:
06/27/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
06/27/2026

Months Since Last Survey:
28

Entity Type Survey Cycle(months):
30

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
2204 Johnson Avenue NW

City:
Cedar Rapids

State:
Iowa

Zip:
52405-4757

Phone:
(319) 363-8116

Fax:
(319) 363-8138

URL:

Administrator/License #:
Pat Giorgio /

Administrator Email:
pgiorgio@evergreenestatescr.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: