Entity Details

Basic

Entity Type:
Organ Procurement Organization (ORGAN)

Medicaid #:

CCN #:
16P001

Occupancy Type:
Beds

Max Occupancy:
0

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
52P001

Initial License Date:

Current License Date:

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
356

Expiration Date:

Months Since Last Survey:

Entity Type Survey Cycle(months):
333

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
550 Madison Avenue

City:
North Liberty

State:
Iowa

Zip:
52317-0000

Phone:
(319) 665-3787

Fax:

URL:

Administrator/License #:
SUZANNE CONRAD /

Administrator Email:

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: