Entity Details

Basic

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

Medicaid #:
0808097

CCN #:
165253

Occupancy Type:
Beds

Max Occupancy:
46

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
390067

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:
9

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
805 East Main Street Box 69

City:
Panora

State:
Iowa

Zip:
50216-0069

Phone:
(641) 219-4335

Fax:

URL:

Administrator/License #:
Jacquelyne Jasek / 116293

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: