Entity Details

Basic

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

Medicaid #:
0800367

CCN #:
165205

Occupancy Type:
Beds

Max Occupancy:
64

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
750130

Initial License Date:

Current License Date:
03/14/2025

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
03/14/2026

Months Since Last Survey:
10

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1140 Lincoln Street NE

City:
Lemars

State:
Iowa

Zip:
51031-3398

Phone:
(712) 546-4101

Fax:
(712) 546-9488

URL:

Administrator/License #:
Tyler Whitcanack / 127775

Administrator Email:
Tyler.Whitcanack@good-sam.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: