Entity Details

Basic

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

Medicaid #:
0809012

CCN #:
165549

Occupancy Type:
Beds

Max Occupancy:
60

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
900687

Initial License Date:
05/20/1994

Current License Date:
05/20/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/19/2024

Months Since Last Survey:
17

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
Three Pennsylvania Place

City:
Ottumwa

State:
Iowa

Zip:
52501-2165

Phone:
(641) 683-3372

Fax:
(641) 683-1031

URL:

Administrator/License #:
Ronald Stursma / 01610

Administrator Email:
ron@vistawoodscarecenter.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: