Entity Details

Basic

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

Medicaid #:
0802702

CCN #:
165374

Occupancy Type:
Beds

Max Occupancy:
46

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
490158

Initial License Date:
11/11/1974

Current License Date:
11/11/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
11/10/2024

Months Since Last Survey:
11

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1201 Park Street

City:
Bellevue

State:
Iowa

Zip:
52031-1911

Phone:
(563) 872-5521

Fax:
(563) 872-5609

URL:

Provisional Administrator:
Lenae Sieverding

Provisional Administrator Email:
lsieverding@millvalleycarecenter.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: