Entity Details

Basic

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

Former Entity Name:
Pearl Valley Rehabilitation And Nursing At Sutherland, Llc

Medicaid #:
0805077

CCN #:
165458

Occupancy Type:
Beds

Max Occupancy:
27

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
710198

Initial License Date:
10/01/1999

Current License Date:
05/14/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/13/2024

Months Since Last Survey:
6

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
11/18/2022

Loss of NA Training Expires:
11/17/2024

Contact

Address:
506 East Fourth Street

City:
Sutherland

State:
Iowa

Zip:
51058-0475

Phone:
(712) 220-9241

Fax:
(712) 446-2633

URL:

Administrator/License #:
Stacy Benna / 02137

Administrator Email:
sbenna@sutherlandltc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: