Entity Details

Basic

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

Former Entity Name:
Pioneer Valley Living And Rehab

Medicaid #:

CCN #:
165615

Occupancy Type:
Beds

Max Occupancy:
66

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
974356

Initial License Date:
02/26/2016

Current License Date:
02/27/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
02/27/2026

Months Since Last Survey:
12

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
400 Sergeant Square Drive

City:
Sergeant Bluff

State:
Iowa

Zip:
51054

Phone:
(712) 943-2350

Fax:
(712) 943-2370

URL:

Administrator/License #:
Stephanie Amick / 002587

Administrator Email:
samick20@gmail.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: