Entity Details

Basic

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

Former Entity Name:
Shady Oaks Care Center

Medicaid #:
0807644

CCN #:
165082

Occupancy Type:
Beds

Max Occupancy:
46

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
130137

Initial License Date:
02/22/1994

Current License Date:
07/01/2026

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/01/2027

Months Since Last Survey:
3

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1409 West Main Street

City:
Lake City

State:
Iowa

Zip:
51449-9701

Phone:
(712) 464-3106

Fax:
(712) 464-8042

URL:

Provisional Administrator:
Kay Torres

Provisional Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: