Entity Details

Basic

Entity Type:
Residential Care Facilities for the Intellectually Disabled (DISCONTINUED ENTITY TYPE) (RCF/ID (DISCONTINUED ENTITY TYPE))

Medicaid #:
0892968

CCN #:

Occupancy Type:
Beds

Max Occupancy:
12

Status:
Closed

Close Date:
06/30/2018

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
070811

Initial License Date:

Current License Date:
05/01/2017

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/01/2018

Months Since Last Survey:
115

Entity Type Survey Cycle(months):
10

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
2221 Fairway Lane

City:
Waterloo

State:
Iowa

Zip:
50701-0000

Phone:
(319) 236-1033

Fax:
(319) 287-4916

URL:

Administrator/License #:
JODIE SCHMIDT /

Administrator Email:
jodie.schmidt@episervice.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: