Entity Details

Basic

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

Medicaid #:
0807396

CCN #:
165352

Occupancy Type:
Beds

Max Occupancy:
46

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
740026

Initial License Date:
11/01/1995

Current License Date:
08/15/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/15/2026

Months Since Last Survey:
4

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
07/28/2025

Loss of NA Training Expires:
07/28/2027

Contact

Address:
2405 21st Street

City:
Emmetsburg

State:
Iowa

Zip:
50536-0490

Phone:
(712) 852-4266

Fax:
(712) 852-4662

URL:

Administrator/License #:
Angelia Mendez / 109675

Administrator Email:
amendez@legacyhc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: