Entity Details

Basic

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

Medicaid #:
0805382

CCN #:
165220

Occupancy Type:
Beds

Max Occupancy:
62

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
290810

Initial License Date:
11/01/2000

Current License Date:
09/17/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
09/17/2025

Months Since Last Survey:
8

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
608 Prairie Street

City:
Mediapolis

State:
Iowa

Zip:
52637-0815

Phone:
(319) 394-3991

Fax:
(402) 442-1315

URL:

Administrator/License #:
Ashley Ames / 121581

Administrator Email:
AAmes@azriahealth.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: