Entity Details

Basic

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

Medicaid #:
0880468

CCN #:
16G032

Occupancy Type:
Beds

Max Occupancy:
20

Status:
Closed

Close Date:
03/11/2024

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
170588

Initial License Date:
03/24/1989

Current License Date:
03/24/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
03/23/2024

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:
1200 North Ninth Street

City:
Clear Lake

State:
Iowa

Zip:
50428-0622

Phone:
(641) 357-5277

Fax:
(641) 357-6491

URL:

Administrator/License #:
Deb Paschal /

Administrator Email:
dpaschal@onevision.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: