Entity Details

Basic

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

Medicaid #:
0800008

CCN #:
165570

Occupancy Type:
Beds

Max Occupancy:
72

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
620049

Initial License Date:
09/01/1993

Current License Date:
04/01/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
04/01/2025

Months Since Last Survey:
5

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1514 High Avenue West

City:
Oskaloosa

State:
Iowa

Zip:
52577-1997

Phone:
(641) 673-7032

Fax:
(641) 673-0068

URL:

Administrator/License #:
Jay Willis / 02000

Administrator Email:
wjaywills@gmail.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: