Entity Details

Basic

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

Former Entity Name:
Rem Iowa Terry Avenue

Medicaid #:
0880450

CCN #:
16G031

Occupancy Type:
Beds

Max Occupancy:
8

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
570139

Initial License Date:

Current License Date:
05/01/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/01/2025

Months Since Last Survey:
4

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
815 Terry Avenue

City:
Hiawatha

State:
Iowa

Zip:
52233-1306

Phone:
(319) 393-3633

Fax:
(319) 393-3718

URL:

Administrator/License #:
Jenette Randall / QIDP

Administrator Email:
Jenette.Randall@sevitahealth.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: