Entity Details

Basic

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

Former Entity Name:
Countryhouse Residences

Medicaid #:

CCN #:

Occupancy Type:
Units

Max Occupancy:
36

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
S0367

Initial License Date:
09/08/2017

Current License Date:
09/08/2025

Renewal Cycle:
730

Entity Type Renewal Cycle(months):
24

Expiration Date:
09/08/2027

Months Since Last Survey:
23

Entity Type Survey Cycle(months):
24

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1831 East Kanesville Blvd.

City:
Council Bluffs

State:
Iowa

Zip:
51503

Phone:
(712) 322-4100

Fax:
(712) 566-1527

URL:

Administrator/License #:
Tanya Brannan /

Administrator Email:
tbrannan@countryhouse.net

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: