Entity Details

Basic

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

Medicaid #:
0800300

CCN #:
165540

Occupancy Type:
Beds

Max Occupancy:
101

Status:
Closed

Close Date:
07/26/2023

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
970370

Initial License Date:

Current License Date:
07/01/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
06/30/2024

Months Since Last Survey:
18

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
06/08/2022

Loss of NA Training Expires:
06/07/2024

Contact

Address:
6120 Morningside Avenue

City:
Sioux City

State:
Iowa

Zip:
51106-3943

Phone:
(712) 276-3000

Fax:
(712) 274-4781

URL:

Provisional Administrator:
Scott Mow

Provisional Administrator Email:
smow@countrysidehealthcarecenter.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: