Entity Details

Basic

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

Medicaid #:

CCN #:

Occupancy Type:
Units

Max Occupancy:
62

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
S0079

Initial License Date:
05/04/2002

Current License Date:
05/03/2024

Renewal Cycle:
730

Entity Type Renewal Cycle(months):
24

Expiration Date:
05/03/2026

Months Since Last Survey:
22

Entity Type Survey Cycle(months):
24

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
5605 Jersey Ridge Rd

City:
Davenport

State:
Iowa

Zip:
52807-3132

Phone:
(563) 355-2027

Fax:
(563) 441-9227

URL:

Administrator/License #:
Niki Gillies / Director

Administrator Email:
ngillies@jerseyridgeplace.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: