Entity Details

Basic

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

Former Entity Name:
Independence Village Of Waukee MC

Medicaid #:

CCN #:

Occupancy Type:
Units

Max Occupancy:
36

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
S0317

Initial License Date:
03/28/2011

Current License Date:
03/28/2025

Renewal Cycle:
730

Entity Type Renewal Cycle(months):
24

Expiration Date:
03/28/2027

Months Since Last Survey:
25

Entity Type Survey Cycle(months):
24

Special Focus Facility:
Yes

Special Focus Facility Survey Cycle(months):
6

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1645 SE Holiday Crest Circle

City:
Waukee

State:
Iowa

Zip:
50263

Phone:
(515) 987-4100

Fax:
(515) 987-5795

URL:

Administrator/License #:
Austin Williams /

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: