Entity Details

Basic

Entity Type:
Free Standing NF/SNF (Free Standing NF/SNF)

Former Entity Name:
Kanawha Community Home, Inc.

Medicaid #:
0802116

CCN #:
165467

Occupancy Type:
Beds

Max Occupancy:
26

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
410433

Initial License Date:

Current License Date:
06/04/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
06/04/2026

Months Since Last Survey:
8

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
130 West Sixth Street

City:
Kanawha

State:
Iowa

Zip:
50447-5026

Phone:
(641) 762-3302

Fax:
(641) 762-3301

URL:

Administrator/License #:
120923 Tiffany / Cartee

Administrator Email:
kchadmin@comm1net.net

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: