Entity Details

Basic

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

Medicaid #:
0808329

CCN #:
165271

Occupancy Type:
Beds

Max Occupancy:
85

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
970354

Initial License Date:
08/01/1989

Current License Date:
08/01/2026

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/01/2027

Months Since Last Survey:
6

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
4201 Fieldcrest Drive

City:
Sioux City

State:
Iowa

Zip:
51103-2401

Phone:
(712) 258-0135

Fax:

URL:

Administrator/License #:
Iden Ramsey / 125337

Administrator Email:
[email protected]

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: