Entity Details

Basic

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

Medicaid #:
0803775

CCN #:
165484

Occupancy Type:
Beds

Max Occupancy:
79

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
210409

Initial License Date:
02/07/1967

Current License Date:
01/31/2026

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
01/31/2027

Months Since Last Survey:
7

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
09/04/2025

Loss of NA Training Expires:
09/04/2027

Contact

Address:
1301 St Luke Drive

City:
Spencer

State:
Iowa

Zip:
51301-6043

Phone:
(712) 262-5931

Fax:
(712) 262-4743

URL:

Administrator/License #:
Ken Nelson / 01838

Administrator Email:
ken.nelson@stlukelh.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: