Entity Details

Basic

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

Former Entity Name:
Mosaic - E 42nd Street

Medicaid #:
0881979

CCN #:
16G014

Occupancy Type:
Beds

Max Occupancy:
8

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
770991

Initial License Date:
07/01/2003

Current License Date:
07/02/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/02/2026

Months Since Last Survey:
3

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
3114 East 42nd Street

City:
Des Moines

State:
Iowa

Zip:
50317-0000

Phone:
(515) 246-1840

Fax:
(515) 246-8236

URL:
http://www.mosaicinfo.org/

Administrator/License #:
Rhonda Willcox /

Administrator Email:
rhonda.willcox@mosaicinfo.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: