Entity Details

Basic

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

Medicaid #:
0880260

CCN #:
16G018

Occupancy Type:
Beds

Max Occupancy:
59

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
310131

Initial License Date:
05/30/1985

Current License Date:
05/31/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/31/2026

Months Since Last Survey:
10

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1011 Davis Avenue

City:
Dubuque

State:
Iowa

Zip:
52001-1397

Phone:
(563) 556-7878

Fax:
(563) 557-3822

URL:

Administrator/License #:
Jack Mescher /

Administrator Email:
jmescher@hillsdales.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: