Entity Details

Basic

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

Former Entity Name:
Behavioral Technologies - Marion

Medicaid #:
0881557

CCN #:
16G132

Occupancy Type:
Beds

Max Occupancy:
4

Status:
Closed

Close Date:
03/31/2023

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
770929

Initial License Date:
06/28/2000

Current License Date:
07/01/2022

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/01/2023

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:
2542 East Marion

City:
Des Moines

State:
Iowa

Zip:
50320-0000

Phone:
(515) 263-9109

Fax:
(515) 263-9115

URL:

Administrator/License #:
Brandi Bretthauer /

Administrator Email:
brandi.bretthauer@mosaicinfo.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: