Entity Details

Basic

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

Medicaid #:
0802520

CCN #:
165579

Occupancy Type:
Beds

Max Occupancy:
46

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
490298

Initial License Date:
03/20/1974

Current License Date:
03/20/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
03/20/2025

Months Since Last Survey:
11

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1202 German Street

City:
Maquoketa

State:
Iowa

Zip:
52060-2055

Phone:
(563) 652-5195

Fax:
(563) 652-5401

URL:

Administrator/License #:
Amanda Carr / 099167

Administrator Email:
acarr@jacksonridgehc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: