Entity Details

Basic

Entity Type:
Intermediate Care Facilities for Persons with Mental Illness (ICF/PMI)

Medicaid #:

CCN #:
165797

Occupancy Type:
Beds

Max Occupancy:
16

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
560181

Initial License Date:
02/01/2011

Current License Date:
02/01/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
02/01/2026

Months Since Last Survey:
19

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
3140 Plank Road

City:
Keokuk

State:
Iowa

Zip:
52632

Phone:
(319) 524-1800

Fax:

URL:

Administrator/License #:
Michael Blume / 002404

Administrator Email:
mblume@seibhc.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: