Entity Details

Basic

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

Medicaid #:
0808212

CCN #:
165263

Occupancy Type:
Beds

Max Occupancy:
39

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
160591

Initial License Date:
08/01/1989

Current License Date:
08/01/2026

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/01/2027

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:
104 East Fourth Street

City:
Mechanicsville

State:
Iowa

Zip:
52306-0430

Phone:
(563) 346-0982

Fax:

URL:

Administrator/License #:
Tina Wendt / 002621

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: