Entity Details

Basic

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

Medicaid #:
0804054

CCN #:
165482

Occupancy Type:
Beds

Max Occupancy:
59

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
920303

Initial License Date:
04/06/2005

Current License Date:
04/06/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/06/2025

Months Since Last Survey:
5

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
03/16/2023

Loss of NA Training Expires:
03/15/2025

Contact

Address:
1203 East Washington

City:
Washington

State:
Iowa

Zip:
52353-2198

Phone:
(319) 653-5473

Fax:
(319) 653-5474

URL:

Administrator/License #:
Erin Drahota / 002785

Administrator Email:
edrahota@uphome.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: