Entity Details

Basic

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

Medicaid #:
0801597

CCN #:
165187

Occupancy Type:
Beds

Max Occupancy:
52

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
330406

Initial License Date:
11/04/2004

Current License Date:
11/04/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
11/04/2026

Months Since Last Survey:
11

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
201 Hall Street

City:
West Union

State:
Iowa

Zip:
52175-1006

Phone:
(563) 422-3814

Fax:
(563) 422-3815

URL:

Administrator/License #:
Ashley Poling / 123576

Administrator Email:
Ashley.Poling@good-sam.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: