Entity Details

Basic

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

Medicaid #:
0801522

CCN #:
165211

Occupancy Type:
Beds

Max Occupancy:
126

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
900279

Initial License Date:
04/20/1971

Current License Date:
04/20/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/20/2026

Months Since Last Survey:
2

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
10/10/2024

Loss of NA Training Expires:
10/09/2026

Contact

Address:
2035 Chester Avenue

City:
Ottumwa

State:
Iowa

Zip:
52501-3798

Phone:
(641) 684-3546

Fax:
(641) 683-9420

URL:

Administrator/License #:
Angela Adam / 080435

Administrator Email:
angela.adammha@good-sam.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: