Entity Details

Basic

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

Medicaid #:
0809236

CCN #:
165537

Occupancy Type:
Beds

Max Occupancy:
109

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
570660

Initial License Date:

Current License Date:
09/01/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
08/31/2024

Months Since Last Survey:
15

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
405 North 15th Avenue

City:
Hiawatha

State:
Iowa

Zip:
52233-2347

Phone:
(319) 378-8583

Fax:
(319) 378-8598

URL:

Administrator/License #:
Kent Walton / 01377

Administrator Email:
kwalton@hiawathacarecenter.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: