Entity Details

Basic

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

Medicaid #:
0803502

CCN #:
165614

Occupancy Type:
Beds

Max Occupancy:
58

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
480183

Initial License Date:

Current License Date:
01/01/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
12/31/2024

Months Since Last Survey:
8

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
11/07/2023

Loss of NA Training Expires:
11/06/2025

Contact

Address:
1500 N Franklyn Avenue

City:
Marengo

State:
Iowa

Zip:
52301-1399

Phone:
(319) 642-5533

Fax:
(319) 642-3822

URL:

Administrator/License #:
Jalissa Winn / 002392

Administrator Email:
Jwinn@rosehavennursinghome.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: