Entity Details

Basic

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

Former Entity Name:
Rem Iowa Mansfield Avenue

Medicaid #:
0880658

CCN #:
16G053

Occupancy Type:
Beds

Max Occupancy:
8

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
570684

Initial License Date:

Current License Date:
05/01/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/01/2026

Months Since Last Survey:
7

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
2901 Mansfield Avenue SE

City:
Cedar Rapids

State:
Iowa

Zip:
52403-4574

Phone:
(319) 364-2005

Fax:
(319) 364-2849

URL:

Administrator/License #:
Staci Siddell / QIDP

Administrator Email:
staci.siddell@thementornetwork.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: