Entity Details

Basic

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

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

Medicaid #:
0804641

CCN #:
165387

Occupancy Type:
Beds

Max Occupancy:
40

Status:
Closed

Close Date:
09/13/2023

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
710178

Initial License Date:

Current License Date:
05/14/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/13/2024

Months Since Last Survey:
10

Entity Type Survey Cycle(months):
12

Special Focus Facility:
Yes

Special Focus Facility Survey Cycle(months):
6

Loss of NA Training Effective:
01/19/2023

Loss of NA Training Expires:
01/18/2025

Contact

Address:
735 North Rerick Avenue

City:
Primghar

State:
Iowa

Zip:
51245-0527

Phone:
(712) 957-3655

Fax:
(712) 957-8501

URL:

Administrator/License #:
Stacy Benna / 02137

Administrator Email:
sbenna@sutherlandltc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: