Entity Details

Basic

Entity Type:
Psychiatric Medical Institutions for Children (PMIC)

Former Entity Name:
Lutheran Services of Iowa. INC Bremwood - Phoenix

Medicaid #:

CCN #:
16L001

Occupancy Type:
Beds

Max Occupancy:
12

Status:
Closed

Close Date:
05/01/2024

Accredited:
Council on Accreditation

Accredited/Deemed:
No Record Found

License & Survey

License #:
09PM40

Initial License Date:
10/01/2003

Current License Date:
11/02/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
11/01/2024

Months Since Last Survey:
32

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
106 16th Street SW Banker Bldg. - 1st Floor

City:
Waverly

State:
Iowa

Zip:
50677-0000

Phone:
(515) 277-4476

Fax:
(515) 271-7454

URL:

Administrator/License #:
Brian Imhoff /

Administrator Email:
brian.imhoff@lsiowa.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: