Entity Details

Basic

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

Former Entity Name:
Pearl Valley Rehabilitation And Nursing At Lake Park, Llc

Medicaid #:
0809731

CCN #:
165445

Occupancy Type:
Beds

Max Occupancy:
46

Status:
Closed

Close Date:
10/16/2024

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
300598

Initial License Date:

Current License Date:
05/14/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/14/2025

Months Since Last Survey:
17

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1304 South Market Street

City:
Lake Park

State:
Iowa

Zip:
51347-0425

Phone:
(712) 272-2130

Fax:
(712) 832-9548

URL:

Administrator/License #:
Jenny Ackerman / 101984

Administrator Email:
ackerman@esthervilleltc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: