Entity Details

Basic

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

Medicaid #:

CCN #:

Occupancy Type:
Units

Max Occupancy:
24

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
S0481

Initial License Date:
11/28/2023

Current License Date:
11/28/2025

Renewal Cycle:

Entity Type Renewal Cycle(months):
24

Expiration Date:
11/28/2027

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:
1702 41st Street

City:
Fort Madison

State:
Iowa

Zip:
52627

Phone:
(319) 372-8021

Fax:
(319) 372-8163

URL:

Administrator/License #:
Brenda Graham /

Administrator Email:
bgraham@birkwoodvillage-fortmadison.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: