Entity Details

Basic

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

Former Entity Name:
Rehabilitation Center Of Lisbon

Medicaid #:

CCN #:
165617

Occupancy Type:
Beds

Max Occupancy:
64

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
576458

Initial License Date:

Current License Date:
08/15/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/15/2025

Months Since Last Survey:
8

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
905 West Main Street

City:
Lisbon

State:
Iowa

Zip:
52253

Phone:
(319) 455-2547

Fax:
(319) 455-3544

URL:

Administrator/License #:
Jessica Vanderploeg / 079467

Administrator Email:
jvanderploeg@legacyhc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: