Entity Details

Basic

Entity Type:
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

Medicaid #:
0881755

CCN #:
16G139

Occupancy Type:
Beds

Max Occupancy:
21

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
570936

Initial License Date:

Current License Date:
04/01/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/01/2026

Months Since Last Survey:
8

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
2309 C Street SW

City:
Cedar Rapids

State:
Iowa

Zip:
52404-3707

Phone:
(319) 365-9164

Fax:
(319) 365-6411

URL:

Administrator/License #:
Jessica Kelly /

Administrator Email:
jkelly@tanagerplace.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: