Entity Details

Basic

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

Medicaid #:
0881417

CCN #:
16G126

Occupancy Type:
Beds

Max Occupancy:
4

Status:
Closed

Close Date:
05/07/2023

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
970070

Initial License Date:
06/01/1996

Current License Date:
06/02/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
06/01/2024

Months Since Last Survey:
24

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
2007 Ravens Court

City:
Sioux City

State:
Iowa

Zip:
51104-0000

Phone:
(712) 277-8295

Fax:
(712) 277-8602

URL:

Administrator/License #:
Jennifer McCabe /

Administrator Email:
jmccabe@opportunitiesunlimited.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: