Entity Details

Basic

Entity Type:
Assisted Living Programs for People with Dementia (ALP/D)

Medicaid #:

CCN #:

Occupancy Type:
Units

Max Occupancy:
32

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
S0022

Initial License Date:
10/15/1998

Current License Date:
12/01/2025

Renewal Cycle:
730

Entity Type Renewal Cycle(months):
24

Expiration Date:
12/01/2027

Months Since Last Survey:
20

Entity Type Survey Cycle(months):
24

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
One Pennsylvania Place

City:
Ottumwa

State:
Iowa

Zip:
52501-2188

Phone:
(641) 684-4000

Fax:
(641) 684-4079

URL:

Administrator/License #:
Brenda Hostetler /

Administrator Email:
bhostetler@pennplace.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: