Entity Details

Basic

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

Medicaid #:
0880153

CCN #:
16G011

Occupancy Type:
Beds

Max Occupancy:
15

Status:
Closed

Close Date:
09/05/2024

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
630890

Initial License Date:

Current License Date:
01/06/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
01/05/2025

Months Since Last Survey:
30

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1554 Broadway

City:
Pella

State:
Iowa

Zip:
50219-1061

Phone:
(641) 628-1162

Fax:
(641) 628-8682

URL:

Administrator/License #:
Shelli Robins /

Administrator Email:
srobins@christianopportunity.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: