Entity Details

Basic

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

Medicaid #:
0804807

CCN #:
165366

Occupancy Type:
Beds

Max Occupancy:
61

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
950927

Initial License Date:

Current License Date:
08/15/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/15/2025

Months Since Last Survey:
3

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
406 South 10th Avenue

City:
Lake Mills

State:
Iowa

Zip:
50450-1851

Phone:
(641) 592-4900

Fax:
(641) 592-2226

URL:

Administrator/License #:
Krystal Thoe / 096150

Administrator Email:
kthoe@legacyhc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: