Entity Details

Basic

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

Medicaid #:
0804484

CCN #:
165436

Occupancy Type:
Beds

Max Occupancy:
75

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
820846

Initial License Date:
07/03/1979

Current License Date:
04/01/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/01/2026

Months Since Last Survey:
11

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
06/24/2024

Loss of NA Training Expires:
06/23/2026

Contact

Address:
800 East Rusholme Street

City:
Davenport

State:
Iowa

Zip:
52803-2599

Phone:
(563) 322-1668

Fax:
(563) 326-1811

URL:

Administrator/License #:
Dawn Bogdan / 132372

Administrator Email:
dbogdan@theivyatdavenport.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: