Entity Details

Basic

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

Medicaid #:
0881003

CCN #:
16G089

Occupancy Type:
Beds

Max Occupancy:
6

Status:
Closed

Close Date:
03/01/2022

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
220424

Initial License Date:
02/18/1994

Current License Date:
02/18/2022

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
02/18/2023

Months Since Last Survey:
33

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
103 North Rutland

City:
Garnavillo

State:
Iowa

Zip:
52049-0458

Phone:
(563) 252-3811

Fax:
(563) 252-3812

URL:

Administrator/License #:
Regina Shafer /

Administrator Email:
rshafer@imagineia.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: