Entity Details

Basic

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

Former Entity Name:
Mosaic- 319 Country Club Drive

Medicaid #:
0880849

CCN #:
16G072

Occupancy Type:
Beds

Max Occupancy:
6

Status:
Closed

Close Date:
04/01/2022

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
990774

Initial License Date:
10/28/1992

Current License Date:
04/01/2021

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/01/2022

Months Since Last Survey:
54

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
319 Country Club Drive

City:
Belmond

State:
Iowa

Zip:
50421-0000

Phone:
(515) 532-3221

Fax:
(515) 602-6972

URL:

Administrator/License #:
Patrick Costigan /

Administrator Email:
patrick.costigan@mosaicinfo.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: