Entity Details

Basic

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

Former Entity Name:
Mosaic-102 Kelly'S Court

Medicaid #:
0880245

CCN #:
16G016

Occupancy Type:
Beds

Max Occupancy:
8

Status:
Closed

Close Date:
12/20/2021

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
950105

Initial License Date:
10/25/1984

Current License Date:
04/01/2021

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/01/2022

Months Since Last Survey:
58

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
905 Hwy 69 South

City:
Forest City

State:
Iowa

Zip:
50436-2100

Phone:
(641) 585-3050

Fax:
(641) 585-3939

URL:

Administrator/License #:
Patrick Costigan / Executive Director

Administrator Email:
patrick.costigan@mosaicinfo.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: