Entity Details

Basic

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

Medicaid #:
0801472

CCN #:
165207

Occupancy Type:
Beds

Max Occupancy:
60

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
470420

Initial License Date:

Current License Date:
07/27/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/26/2024

Months Since Last Survey:
4

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
505 West Second Street

City:
Holstein

State:
Iowa

Zip:
51025-5111

Phone:
(712) 368-4304

Fax:
(712) 368-2104

URL:

Administrator/License #:
Troy Anderson / 01981

Administrator Email:
tander51@good-sam.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: