Entity Details

Basic

Entity Type:
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

Former Entity Name:
Mosaic-217 Maple Avenue

Medicaid #:
0881284

CCN #:
16G113

Occupancy Type:
Beds

Max Occupancy:
6

Status:
Closed

Close Date:
11/08/2021

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
850442

Initial License Date:

Current License Date:
04/01/2021

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/01/2022

Months Since Last Survey:
42

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
217 Maple Avenue

City:
Nevada

State:
Iowa

Zip:
50201-0300

Phone:
(515) 382-5520

Fax:
(515) 382-6380

URL:

Administrator/License #:
Brandi Bretthauer /

Administrator Email:
brandi.bretthauer@mosaicinfo.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: