Entity Details

Basic

Entity Type:
Assisted Living Programs for People with Dementia (ALP/D)

Former Entity Name:
Keystone Place at Forevergreen MC

Medicaid #:

CCN #:

Occupancy Type:
Units

Max Occupancy:
40

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
S0360

Initial License Date:
10/31/2016

Current License Date:
11/01/2024

Renewal Cycle:
730

Entity Type Renewal Cycle(months):
24

Expiration Date:
11/01/2026

Months Since Last Survey:
21

Entity Type Survey Cycle(months):
24

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1275 West Forevergreen Road

City:
North Liberty

State:
Iowa

Zip:
52317

Phone:
(319) 459-1964

Fax:
(319) 459-1967

URL:

Administrator/License #:
Quinn Hackert /

Administrator Email:
qhackert@keystonesenior.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: