Entity Details

Basic

Entity Type:
Subacute Mental Health Facilities (Subacute Mental Health Facilities)

Medicaid #:

CCN #:

Occupancy Type:
Beds

Max Occupancy:
10

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
077542

Initial License Date:
02/14/2018

Current License Date:
02/15/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
02/15/2026

Months Since Last Survey:
6

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1440 W. Dunkerton Road

City:
Waterloo

State:
Iowa

Zip:
50703

Phone:
(319) 291-2455

Fax:
(319) 291-2464

URL:

Administrator/License #:
Amber Lacina /

Administrator Email:
ambernijds@gmail.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: