Entity Details

Basic

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

Former Entity Name:
Imagine The Possibilities, Inc - Prairie House

Medicaid #:
0880575

CCN #:
16G045

Occupancy Type:
Beds

Max Occupancy:
12

Status:
Closed

Close Date:
09/01/2022

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
490625

Initial License Date:

Current License Date:
02/09/2022

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
02/09/2023

Months Since Last Survey:
32

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
201 North Olive Street

City:
Maquoketa

State:
Iowa

Zip:
52060-9214

Phone:
(563) 652-2848

Fax:
(563) 652-4872

URL:

Administrator/License #:
Eudora Beckley /

Administrator Email:
ebeckley@imagineia.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: