Entity Details

Basic

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

Former Entity Name:
Promedica Skilled Nursing and Rehabilitation - Davenport

Medicaid #:
0800002

CCN #:
165033

Occupancy Type:
Beds

Max Occupancy:
93

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
820400

Initial License Date:
06/28/1982

Current License Date:
04/01/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/01/2026

Months Since Last Survey:
1

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
08/24/2023

Loss of NA Training Expires:
08/23/2025

Contact

Address:
815 East Locust Street

City:
Davenport

State:
Iowa

Zip:
52803-0000

Phone:
(563) 324-3276

Fax:
(563) 324-8844

URL:

Administrator/License #:
Rachel May / 101609

Administrator Email:
rmay@legacyhc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: