Entity Details

Basic

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

Medicaid #:
0803866

CCN #:
165556

Occupancy Type:
Beds

Max Occupancy:
77

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
310304

Initial License Date:

Current License Date:
04/08/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/08/2025

Months Since Last Survey:
16

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
2375 Roosevelt Street

City:
Dubuque

State:
Iowa

Zip:
52001-1392

Phone:
(563) 583-1781

Fax:
(563) 583-1705

URL:

Administrator/License #:
Danielle Ettema / 02338

Administrator Email:
dani.ettema@dubuquecounty.us

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: