Entity Details

Basic

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

Medicaid #:
0809491

CCN #:
165245

Occupancy Type:
Beds

Max Occupancy:
64

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
840877

Initial License Date:

Current License Date:
07/18/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/17/2024

Months Since Last Survey:
3

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
01/31/2024

Loss of NA Training Expires:
01/30/2026

Contact

Address:
2121 Avenue L

City:
Hawarden

State:
Iowa

Zip:
51023-1333

Phone:
(712) 551-1074

Fax:
(712) 551-2393

URL:

Administrator/License #:
Ashley Poling / 124358

Administrator Email:
APoling@ensignservices.net

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: