Entity Details

Basic

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

Former Entity Name:
Opportunity Living I

Medicaid #:
0880476

CCN #:
16G036

Occupancy Type:
Beds

Max Occupancy:
32

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
130556

Initial License Date:

Current License Date:
04/01/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/01/2025

Months Since Last Survey:
0

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
105 Westview

City:
Lake City

State:
Iowa

Zip:
51449-7006

Phone:
(712) 464-8961

Fax:
(712) 464-3320

URL:

Administrator/License #:
Shannon Mahannah /

Administrator Email:
smahannah@opportunityliving.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: