Entity Details

Basic

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

Medicaid #:
0804732

CCN #:
165365

Occupancy Type:
Beds

Max Occupancy:
80

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
170382

Initial License Date:
01/12/1983

Current License Date:
08/15/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/15/2025

Months Since Last Survey:
12

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
400 Highway 18 West

City:
Clear Lake

State:
Iowa

Zip:
50428-1108

Phone:
(641) 357-5244

Fax:
(641) 357-7154

URL:

Administrator/License #:
Krystal Thoe / 096150

Administrator Email:
kthoe@legacyhc.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: