Entity Details

Basic

Entity Type:
Home Health Agencies (HHA)

Medicaid #:

CCN #:
167055

Occupancy Type:
Beds

Max Occupancy:
0

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:

Initial License Date:

Current License Date:

Renewal Cycle:

Entity Type Renewal Cycle(months):
356

Expiration Date:

Months Since Last Survey:
26

Entity Type Survey Cycle(months):
36

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
5001 Avenue O

City:
Fort Madison

State:
Iowa

Zip:
52627-0000

Phone:
(319) 372-5225

Fax:
(319) 372-4374

URL:

Administrator/License #:
Michelle Ross / Administrator

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: