Entity Details

Basic

Entity Type:
Free Standing NF/SNF (Free Standing NF/SNF)

Medicaid #:
0804864

CCN #:
165338

Occupancy Type:
Beds

Max Occupancy:
46

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
030421

Initial License Date:

Current License Date:
08/15/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/15/2025

Months Since Last Survey:
5

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
960 Fourth Street NW

City:
Waukon

State:
Iowa

Zip:
52172-1034

Phone:
(563) 568-3493

Fax:
(563) 568-3494

URL:

Administrator/License #:
Lou Ann Wikan / 01125

Administrator Email:
lwikan@northgatecarecenter.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: