Entity Details

Basic

Entity Type:
Home Health Agencies (HHA)

Medicaid #:

CCN #:
167014

Occupancy Type:
Beds

Max Occupancy:
0

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
Accreditation Commission for Health Care, Inc

License & Survey

License #:

Initial License Date:

Current License Date:

Renewal Cycle:

Entity Type Renewal Cycle(months):
356

Expiration Date:

Months Since Last Survey:
205

Entity Type Survey Cycle(months):
36

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1524 Sycamore Street

City:
Iowa City

State:
Iowa

Zip:
52240-6021

Phone:
(319) 337-9686

Fax:
(319) 337-5566

URL:

Administrator/License #:
SUELLEN NOVOTNY /

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: