Entity Details

Basic

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

Former Entity Name:
Qhc Humboldt North, Llc

Medicaid #:
0801969

CCN #:
165533

Occupancy Type:
Beds

Max Occupancy:
90

Status:
Closed

Close Date:
02/24/2023

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
460216

Initial License Date:

Current License Date:
05/01/2022

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/01/2023

Months Since Last Survey:
33

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1111 11th Avenue North

City:
Humboldt

State:
Iowa

Zip:
50548-0000

Phone:
(515) 332-2623

Fax:
(515) 332-2653

URL:

Administrator/License #:
Stacy Benna / 02137

Administrator Email:
sbenna@humboldtwr.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: