Entity Details

Basic

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

Medicaid #:
0804849

CCN #:
165340

Occupancy Type:
Beds

Max Occupancy:
72

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
330350

Initial License Date:
10/14/1964

Current License Date:
08/15/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/15/2025

Months Since Last Survey:
2

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
800 Fifth Street SE

City:
Oelwein

State:
Iowa

Zip:
50662-2547

Phone:
(319) 283-1908

Fax:
(319) 283-7058

URL:

Administrator/License #:
Craig Allen / 01983

Administrator Email:
callen@legacyhc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: