Entity Details

Basic

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

Medicaid #:
0807354

CCN #:
165175

Occupancy Type:
Beds

Max Occupancy:
80

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
770707

Initial License Date:

Current License Date:
08/01/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/31/2024

Months Since Last Survey:
8

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
04/27/2023

Loss of NA Training Expires:
04/26/2025

Contact

Address:
5608 SW Ninth Street

City:
Des Moines

State:
Iowa

Zip:
50315-0000

Phone:
(515) 285-3070

Fax:
(515) 285-6020

URL:

Administrator/License #:
Craig Namanny / 112570

Administrator Email:
CNamanny@mgmhealthcare.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: