Entity Details

Basic

Entity Type:
Free Standing NF/SNF (Free Standing NF/SNF)

Former Entity Name:
Urbandale Health Care Center

Medicaid #:

CCN #:
165580

Occupancy Type:
Beds

Max Occupancy:
115

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
771099

Initial License Date:
06/20/2007

Current License Date:
07/01/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/01/2025

Months Since Last Survey:
9

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
12/06/2023

Loss of NA Training Expires:
12/05/2025

Contact

Address:
4614 NW 84th Street

City:
Urbandale

State:
Iowa

Zip:
50322-1089

Phone:
(515) 270-6838

Fax:
(515) 278-5693

URL:

Administrator/License #:
Sharon DeSpain / 090137

Administrator Email:
Admin@urbandalehealth.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: