Entity Details

Basic

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

Medicaid #:

CCN #:

Occupancy Type:
Units

Max Occupancy:
128

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
S0264

Initial License Date:
11/08/2007

Current License Date:
11/08/2025

Renewal Cycle:
730

Entity Type Renewal Cycle(months):
24

Expiration Date:
11/08/2027

Months Since Last Survey:
18

Entity Type Survey Cycle(months):
24

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
2067 Highway 4

City:
Panora

State:
Iowa

Zip:
50216-8696

Phone:
(641) 755-3443

Fax:
(641) 755-3980

URL:

Administrator/License #:
Melissa Borgeson /

Administrator Email:
mborgeson@thelakesidevillage.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: