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:
07/18/2026

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/18/2027

Months Since Last Survey:
5

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
04/22/2026

Loss of NA Training Expires:
04/22/2028

Contact

Address:
2121 Avenue L

City:
Hawarden

State:
Iowa

Zip:
51023-1333

Phone:
(712) 551-1074

Fax:
(712) 551-2393

URL:

Provisional Administrator:
Becca Crouch

Provisional Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: