Entity Details

Basic

Entity Type:
Home Health Agencies (HHA)

Medicaid #:

CCN #:
167299

Occupancy Type:
Beds

Max Occupancy:
0

Status:
Active

Close Date:

Accredited:
The Joint Commission

Accredited/Deemed:
The Joint Commission

License & Survey

License #:

Initial License Date:

Current License Date:

Renewal Cycle:

Entity Type Renewal Cycle(months):
356

Expiration Date:

Months Since Last Survey:
60

Entity Type Survey Cycle(months):
36

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
417 East 1st Street

City:
Monticello

State:
Iowa

Zip:
52310

Phone:
(319) 465-3059

Fax:
(319) 465-4070

URL:

Administrator/License #:
Becky Oliva / Administrator/Owner

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: