Entity Details

Basic

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

Medicaid #:
0801308

CCN #:
165291

Occupancy Type:
Beds

Max Occupancy:
155

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
940037

Initial License Date:

Current License Date:
03/27/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
03/27/2025

Months Since Last Survey:
3

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
420 South Kenyon Road

City:
Fort Dodge

State:
Iowa

Zip:
50501-5793

Phone:
(515) 573-6956

Fax:
(515) 573-6077

URL:

Administrator/License #:
Erin Hoversten / 115123

Administrator Email:
erin.hoversten@friendshiphaven.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: