Entity Details

Basic

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

Medicaid #:
0808139

CCN #:
165193

Occupancy Type:
Beds

Max Occupancy:
46

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
430079

Initial License Date:
08/01/1989

Current License Date:
08/01/2026

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/01/2027

Months Since Last Survey:
2

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1403 Harrison Road

City:
Dunlap

State:
Iowa

Zip:
51529-9737

Phone:
(712) 643-2121

Fax:
(712) 643-2148

URL:

Administrator/License #:
Ruth David-Jones / 134919

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: