Entity Details

Basic

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

Former Entity Name:
Keosauqua Health Care Center

Medicaid #:
0800166

CCN #:
165204

Occupancy Type:
Beds

Max Occupancy:
60

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
890248

Initial License Date:

Current License Date:
07/01/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/01/2025

Months Since Last Survey:
7

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
05/02/2024

Loss of NA Training Expires:
05/01/2026

Contact

Address:
819 Country Lane Road

City:
Keosauqua

State:
Iowa

Zip:
52565-1001

Phone:
(319) 293-3761

Fax:
(319) 293-3764

URL:

Provisional Administrator:
Calla Mallett

Provisional Administrator Email:
admin@countrylanemanor.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: