Entity Details

Basic

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

Medicaid #:
0800301

CCN #:
165795

Occupancy Type:
Beds

Max Occupancy:
57

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
250138

Initial License Date:
12/14/2020

Current License Date:
12/14/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
12/14/2025

Months Since Last Survey:
10

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1300 28TH STREET

City:
Perry

State:
Iowa

Zip:
50220

Phone:
(515) 465-5316

Fax:

URL:

Administrator/License #:
Melissa Gannon / 086835

Administrator Email:
mgannon@perrylutheranhomes.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: