Entity Details

Basic

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

Former Entity Name:
Rem Iowa Coralville

Medicaid #:
0880583

CCN #:
16G044

Occupancy Type:
Beds

Max Occupancy:
8

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
520266

Initial License Date:
05/01/2003

Current License Date:
05/01/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/01/2025

Months Since Last Survey:
6

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1985 Holiday Road

City:
Coralville

State:
Iowa

Zip:
52241-1086

Phone:
(319) 354-0788

Fax:
(319) 545-1227

URL:

Administrator/License #:
Jenette Randall /

Administrator Email:
Jenette.Randall@sevitahealth.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: