Entity Details

Basic

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

Medicaid #:
0880369

CCN #:
16G023

Occupancy Type:
Beds

Max Occupancy:
45

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
970373

Initial License Date:
03/25/1987

Current License Date:
03/25/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
03/25/2025

Months Since Last Survey:
2

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
2815 Lincoln Way

City:
Sioux City

State:
Iowa

Zip:
51106-1912

Phone:
(712) 276-2825

Fax:
(712) 276-2827

URL:

Administrator/License #:
Leslie Ritchie /

Administrator Email:
lritchie@midstepservices.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: