Entity Details

Basic

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

Medicaid #:
0881094

CCN #:
16G096

Occupancy Type:
Beds

Max Occupancy:
6

Status:
Closed

Close Date:
03/01/2022

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
220516

Initial License Date:
05/20/1994

Current License Date:
05/20/2021

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/20/2022

Months Since Last Survey:
53

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
307 West Chestnut

City:
Garnavillo

State:
Iowa

Zip:
52052-0967

Phone:
(319) 252-3811

Fax:
(319) 252-3812

URL:

Administrator/License #:
Regina Shafer /

Administrator Email:
rshafer@imagineia.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: