Entity Details

Basic

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

Former Entity Name:
Behavioral Technologies - Delta

Medicaid #:
0880286

CCN #:
16G020

Occupancy Type:
Beds

Max Occupancy:
8

Status:
Closed

Close Date:
06/30/2023

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
770224

Initial License Date:
05/01/1986

Current License Date:
07/01/2022

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/01/2023

Months Since Last Survey:
25

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1200 Williams Street

City:
Des Moines

State:
Iowa

Zip:
50317-0000

Phone:
(515) 263-9109

Fax:

URL:

Administrator/License #:
Brandi Bretthauer /

Administrator Email:
brandi.bretthauer@mosaicinfo.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: