Entity Details

Basic

Entity Type:
Assisted Living Programs for People with Dementia (ALP/D)

Medicaid #:

CCN #:

Occupancy Type:
Units

Max Occupancy:
38

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
S0017

Initial License Date:
06/30/1998

Current License Date:
06/30/2024

Renewal Cycle:
730

Entity Type Renewal Cycle(months):
24

Expiration Date:
06/30/2026

Months Since Last Survey:
13

Entity Type Survey Cycle(months):
24

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
900 W 46th St

City:
Davenport

State:
Iowa

Zip:
52806-0000

Phone:
(563) 391-1111

Fax:
(563) 391-6267

URL:

Administrator/License #:
Kareicia Mahleu / Director

Administrator Email:
director@countrymanormc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: