Entity Details

Basic

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

Medicaid #:
0805242

CCN #:
165606

Occupancy Type:
Beds

Max Occupancy:
79

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
250186

Initial License Date:
10/31/1999

Current License Date:
10/31/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
10/30/2024

Months Since Last Survey:
13

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
11/21/2023

Loss of NA Training Expires:
11/20/2025

Contact

Address:
2323 E Willis Avenue

City:
Perry

State:
Iowa

Zip:
50220-2148

Phone:
(515) 465-5342

Fax:
(515) 465-5344

URL:

Administrator/License #:
Melissa Gannon / 086835

Administrator Email:
mgannon@perrylutheranhomes.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: