Entity Details

Basic

Entity Type:
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

Medicaid #:

CCN #:
16G161

Occupancy Type:
Beds

Max Occupancy:
10

Status:
Closed

Close Date:
12/31/2022

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
410923

Initial License Date:
09/02/2020

Current License Date:
09/02/2022

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
09/02/2023

Months Since Last Survey:
29

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
755/765 Pebblestone

City:
Garner

State:
Iowa

Zip:
50438

Phone:
(641) 357-5277

Fax:

URL:

Administrator/License #:
Deb Paschal /

Administrator Email:
dpaschal@onevision.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: