Entity Details

Basic

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

Former Entity Name:
Mosaic-101 Kelly'S Court

Medicaid #:

CCN #:
16G155

Occupancy Type:
Beds

Max Occupancy:
8

Status:
Closed

Close Date:
06/01/2022

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
950155

Initial License Date:
04/01/2012

Current License Date:
04/01/2022

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/01/2023

Months Since Last Survey:
58

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
905 Hwy 69 S

City:
Forest City

State:
Iowa

Zip:
50436-0368

Phone:
(641) 585-3050

Fax:
(641) 585-3939

URL:

Administrator/License #:
Patrick Costigan / Executive Director

Administrator Email:
patrick.costigan@mosaicinfo.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: