Entity Details

Basic

Entity Type:
Residential Care Facilities (RCF)

Medicaid #:
0896407

CCN #:

Occupancy Type:
Beds

Max Occupancy:
15

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
770488

Initial License Date:
03/01/1997

Current License Date:
01/02/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
01/01/2025

Months Since Last Survey:
23

Entity Type Survey Cycle(months):
30

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1725 Sixth Avenue

City:
Des Moines

State:
Iowa

Zip:
50314-3304

Phone:
(515) 207-0883

Fax:
(515) 207-8130

URL:

Administrator/License #:
Kurt Pagliai / Provisional

Administrator Email:
kurt.pagliai@vitahs.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: