Entity Details

Basic

Entity Type:
Home Health Agencies (HHA)

Medicaid #:

CCN #:
167157

Occupancy Type:

Max Occupancy:
0

Status:
Closed

Close Date:
10/20/2024

Accredited:
No Record Found

Accredited/Deemed:
The Joint Commission

License & Survey

License #:

Initial License Date:

Current License Date:

Renewal Cycle:

Entity Type Renewal Cycle(months):
24

Expiration Date:

Months Since Last Survey:
151

Entity Type Survey Cycle(months):
36

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
705 Avenue G

City:
Fort Madison

State:
Iowa

Zip:
52627-0327

Phone:
(319) 372-8023

Fax:
(319) 372-8770

URL:

Administrator/License #:
Tammy Shipman / Administrator

Administrator Email:
mobnurse@mobilenursingservices.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: