Entity Details

Basic

Entity Type:
Free Standing NF/SNF (Free Standing NF/SNF)

Medicaid #:

CCN #:
165610

Occupancy Type:
Beds

Max Occupancy:
46

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
770080

Initial License Date:

Current License Date:
07/01/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
06/30/2024

Months Since Last Survey:
14

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
2785 1st Avenue S

City:
Altoona

State:
Iowa

Zip:
50009-8820

Phone:
(515) 967-8700

Fax:
(866) 513-6306

URL:
http/www.prairievistavillage.com

Administrator/License #:
John Freeman / 002424

Administrator Email:
executivedirector@prairievistavillage.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: