Entity Details

Basic

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

Medicaid #:
0806919

CCN #:
165174

Occupancy Type:
Beds

Max Occupancy:
71

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
970125

Initial License Date:
05/01/1986

Current License Date:
02/01/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
01/31/2025

Months Since Last Survey:
13

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
2121 West 19th Street

City:
Sioux City

State:
Iowa

Zip:
51103-2333

Phone:
(712) 233-3127

Fax:
(712) 258-1177

URL:

Provisional Administrator:
Tina Tassler

Provisional Administrator Email:
admin.casadepaz@arboretahc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: