Entity Details

Basic

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

Medicaid #:
0880021

CCN #:
16G003

Occupancy Type:
Beds

Max Occupancy:
851

Status:
Closed

Close Date:
06/17/2024

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
650152

Initial License Date:

Current License Date:
01/03/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
01/02/2025

Months Since Last Survey:
14

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
711 South Vine Street

City:
Glenwood

State:
Iowa

Zip:
51534-0000

Phone:
(712) 525-1252

Fax:
(712) 525-1307

URL:

Administrator/License #:
Marsha Edgington /

Administrator Email:
medging@dhs.state.ia.us

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: