Entity Details

Basic

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

Medicaid #:
0880435

CCN #:
16G029

Occupancy Type:
Beds

Max Occupancy:
16

Status:
Closed

Close Date:
04/27/2022

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
740018

Initial License Date:
02/08/1989

Current License Date:
03/02/2022

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
03/02/2023

Months Since Last Survey:
36

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1505 East Fifth Street

City:
Emmetsburg

State:
Iowa

Zip:
50536-0279

Phone:
(712) 852-2267

Fax:
(712) 852-2362

URL:

Administrator/License #:
Sharri Mason /

Administrator Email:
sharrim@kathleenscare.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: