Entity Details

Basic

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

Medicaid #:
0880252

CCN #:
16G017

Occupancy Type:
Beds

Max Occupancy:
45

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
970172

Initial License Date:

Current License Date:
03/25/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
03/25/2026

Months Since Last Survey:
6

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
5945 Morningside Avenue

City:
Sioux City

State:
Iowa

Zip:
51106-3940

Phone:
(712) 276-9113

Fax:
(712) 276-9115

URL:

Administrator/License #:
Traci Llanos /

Administrator Email:
tllanos@midstepservices.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: