Entity Details

Basic

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

Medicaid #:
0801480

CCN #:
165186

Occupancy Type:
Beds

Max Occupancy:
115

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
910035

Initial License Date:

Current License Date:
01/01/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
12/31/2024

Months Since Last Survey:
9

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
01/10/2024

Loss of NA Training Expires:
01/09/2026

Contact

Address:
708 South Jefferson

City:
Indianola

State:
Iowa

Zip:
50125-0319

Phone:
(515) 961-2596

Fax:
(515) 961-2860

URL:
http://www.good-sam.com

Administrator/License #:
Natasha Blackburn / 090753

Administrator Email:
natasha.blackburn@good-sam.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: