Entity Details

Basic

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

Medicaid #:
0801423

CCN #:
165169

Occupancy Type:
Beds

Max Occupancy:
119

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
820472

Initial License Date:
02/14/1962

Current License Date:
02/14/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
02/13/2025

Months Since Last Survey:
1

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
08/09/2022

Loss of NA Training Expires:
08/08/2024

Contact

Address:
700 Waverly Road

City:
Davenport

State:
Iowa

Zip:
52804-4300

Phone:
(563) 324-1651

Fax:
(563) 336-3963

URL:

Administrator/License #:
Ann Jackson-Sieprawski / 074860

Administrator Email:
ann.jacksonsieprawski@good-sam.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: