Entity Details

Basic

Entity Type:
Intermediate Care Facilities for Persons with Mental Illness (ICF/PMI)

Medicaid #:
0850024

CCN #:
16F001

Occupancy Type:
Beds

Max Occupancy:
32

Status:
Closed

Close Date:
11/04/2024

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
260567

Initial License Date:
01/01/1995

Current License Date:
10/01/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
10/01/2025

Months Since Last Survey:
30

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
22425 Overland Avenue

City:
Bloomfield

State:
Iowa

Zip:
52537-7169

Phone:
(641) 664-3202

Fax:
(641) 664-3221

URL:

Administrator/License #:
Dawn McCarty / 02145

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: