Entity Details

Basic

Entity Type:
Free Standing NF (Free Standing NF)

Medicaid #:
0806042

CCN #:
16A002

Occupancy Type:
Beds

Max Occupancy:
702

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
640108

Initial License Date:

Current License Date:
01/05/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
01/04/2025

Months Since Last Survey:
14

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
1301 Summit Street

City:
Marshalltown

State:
Iowa

Zip:
50158-5485

Phone:
(641) 752-1501

Fax:
(641) 753-4278

URL:

Administrator/License #:
Penny Cutler Bermudez / 085140

Administrator Email:
penny.cutlerbermudez@ivh.state.ia.us

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: